Martin, Diane Watson
Martin, Diane Watson is an sole proprietor health care provider with primary practice located at 4460 Central Way Suite 2, Chubbuck ID 83202-5095. She recently has only one registered license in Behavioral Health & Social Service Providers / Mental Health, which is considered as her primary health care specialty. Martin, Diane Watson can be contacted via phone (208) 237-1711.Contact Information
Primary practice address
4460 Central Way Suite 2
Chubbuck ID 83202-5095
Phone: (208) 237-1711
Fax: (208) 237-5192
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Mental Health | 101YM0800X | LCSW726 | Idaho |
Profile Details
| NPI number | 1265678387 |
|---|---|
| LBN Legal business name | Martin, Diane Watson |
| Credentials | Licensed Clinical Social Worker (LCSW) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Dec 18th, 2008 |
| Last updated | Dec 18th, 2008 - about 16 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1265678387 | NPPES |
| Idaho | MEDICAID | 807197600 |
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