Provider Demographics
NPI:1366770406
Name:HOVEY, DIANE LYNN
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:LYNN
Last Name:HOVEY
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 1:4505 WHITE BEAR PKWY STE 1500
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-3697
Mailing Address - Country:US
Mailing Address - Phone:651-493-8150
Mailing Address - Fax:651-493-9335
Practice Address - Street 1:4505 WHITE BEAR PKWY STE 1500
Practice Address - Street 2:
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110
Practice Address - Country:US
Practice Address - Phone:651-493-8150
Practice Address - Fax:651-493-9335
Is Sole Proprietor?:No
Enumeration Date:2009-12-01
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1967106H00000X
C2007-105102X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No102X00000XBehavioral Health & Social Service ProvidersPoetry Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1366770406Medicaid