Most Relevant Information
Provider Data
| NPI Number: | 1003329905 |
| Provider Name: | DIANE SMITH |
| Entity Type: | Individual |
| Taxonomy Code: | 101Y00000X |
| Specialty: | Counselor |
| License Number: | LCPC-8350 |
Most Important Dates
| Enumeration Date: | 11/14/2017 |
| Last Updated: | 05/01/2024 |
Provider Practice Location
2131 S BONITO WAY
MERIDIAN
ID
836421659
Practice Location Phone/Fax
| Phone: | 2082024732 |
| Fax: |
Provider Mailing Location
2131 S BONITO WAY
MERIDIAN
ID
836421659
Provider Mailing Phone/Fax
| Phone: | 2082024732 |
| Fax: |