Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 6301009357 | MI |
Y | 103T00000X | Psychologist | 6301009357 | MI |
NPI | 1003800889 |
---|---|
Provider Name | Diana Lynn Spring |
First Address | Owosso, MI 48867-0428 |
Second Address | Owosso, MI 48867-9775 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2005 |
Last Update Date | 30/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0995781 | HEALTHPLUS (01) | MI |
6224176 | DBH (01) |