Basic Information
| Provider Information | |||||||||
| NPI: | 1275736282 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BULLER TORRES | ||||||||
| FirstName: | DIANA | ||||||||
| MiddleName: | RAE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LSCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 720 MEDICAL CENTER DR | ||||||||
| Address2: | |||||||||
| City: | NEWTON | ||||||||
| State: | KS | ||||||||
| PostalCode: | 671148778 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3162836103 | ||||||||
| FaxNumber: | 3162831333 | ||||||||
| Practice Location | |||||||||
| Address1: | 126 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | HALSTEAD | ||||||||
| State: | KS | ||||||||
| PostalCode: | 670561708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3168353700 | ||||||||
| FaxNumber: | 3162831333 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2007 | ||||||||
| LastUpdateDate: | 01/18/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 2348 | KS | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 200442150A | 05 | KS | MEDICAID |