Provider Demographics
NPI:1548378771
Name:KRUSE, DIANNE KAY (LCPC MA, EED, EDS)
Entity type:Individual
Prefix:MRS
First Name:DIANNE
Middle Name:KAY
Last Name:KRUSE
Suffix:
Gender:F
Credentials:LCPC MA, EED, EDS
Other - Prefix:MRS
Other - First Name:DIANNE
Other - Middle Name:KAY
Other - Last Name:HICKEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCPC
Mailing Address - Street 1:1214 12TH AVE S
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651
Mailing Address - Country:US
Mailing Address - Phone:208-466-2666
Mailing Address - Fax:208-467-4598
Practice Address - Street 1:1214 12TH AVE S
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651
Practice Address - Country:US
Practice Address - Phone:208-466-2666
Practice Address - Fax:208-467-4598
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID148101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional