Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 1281 | MT |
NPI | 1003051046 |
---|---|
Provider Name | Dianna L. Keane |
First Address | Loma, MT 59460-7716 |
Second Address | Loma, MT 59460-7716 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2008 |
Last Update Date | 04/12/2008 |