Provider Demographics
NPI:1104310598
Name:TRIEB, DIANA MARLENE
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:MARLENE
Last Name:TRIEB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 N RAINBOW BLVD APT 2123
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-4528
Mailing Address - Country:US
Mailing Address - Phone:702-882-1747
Mailing Address - Fax:
Practice Address - Street 1:7281 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-1592
Practice Address - Country:US
Practice Address - Phone:702-870-7050
Practice Address - Fax:885-645-1415
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-19
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV17457106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician