MEDICARE: DIANA DRIVER LPC CANDIDATE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972059020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA DRIVER LPC CANDIDATE

Provider Business Mailing Address
First Line	:	2460 NW 39TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-8956
Country	:	US
Telephone Number	:	405-948-1770
Fax Number	:	405-943-7177

Provider Business Practice Location Address
First Line	:	2460 NW 39TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-8956
Country	:	US
Telephone Number	:	405-948-1770
Fax Number	:	405-943-7177

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2016
Last Update Date	:	08/29/2016

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Directions to “ DIANA DRIVER LPC CANDIDATE” Practice Location

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