Provider Demographics
NPI:1972059020
Name:DRIVER, DIANA (LPC CANDIDATE)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:DRIVER
Suffix:
Gender:F
Credentials:LPC CANDIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2460 NW 39TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-8956
Mailing Address - Country:US
Mailing Address - Phone:405-948-1770
Mailing Address - Fax:405-943-7177
Practice Address - Street 1:2460 NW 39TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-8956
Practice Address - Country:US
Practice Address - Phone:405-948-1770
Practice Address - Fax:405-943-7177
Is Sole Proprietor?:No
Enumeration Date:2016-08-29
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100679850AMedicaid