Provider Demographics
NPI:1053907287
Name:DIEL, KRYSTAL A (LCSW)
Entity type:Individual
Prefix:MS
First Name:KRYSTAL
Middle Name:A
Last Name:DIEL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 6TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:RONAN
Mailing Address - State:MT
Mailing Address - Zip Code:59864-2600
Mailing Address - Country:US
Mailing Address - Phone:406-676-3600
Mailing Address - Fax:406-676-3738
Practice Address - Street 1:126 6TH AVE SW
Practice Address - Street 2:
Practice Address - City:RONAN
Practice Address - State:MT
Practice Address - Zip Code:59864-2600
Practice Address - Country:US
Practice Address - Phone:406-676-3600
Practice Address - Fax:406-676-3738
Is Sole Proprietor?:No
Enumeration Date:2020-12-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT451621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical