| Diana Blackwell, LCSW | |
|
508 N Truman Blvd Ste F, Crystal City, MO 63019-1344 | |
| (636) 931-8784 | |
| (636) 465-0026 |
| Full Name | Diana Blackwell |
|---|---|
| Gender | Female |
| Speciality | Social Worker - Clinical |
| Location | 508 N Truman Blvd Ste F, Crystal City, Missouri |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811088446 | NPI | - | NPPES |
| 493964837 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 005911 (Missouri) | Primary |
| Entity Name | Advanced Psychiatric Services Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1154372464 PECOS PAC ID: 8820074297 Enrollment ID: O20040710000000 |
| Entity Name | Psychotherapy Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1164203188 PECOS PAC ID: 0143769828 Enrollment ID: O20240826002840 |
| Mailing Address | Practice Location Address |
|---|---|
| Diana Blackwell, LCSW 508 N Truman Blvd Ste F, Crystal City, MO 63019-1344 Ph: (636) 931-8784 | Diana Blackwell, LCSW 508 N Truman Blvd Ste F, Crystal City, MO 63019-1344 Ph: (636) 931-8784 |
Mrs. Laura L Lukowski, LCSW Clinical Social Worker Medicare: Accepting Medicare Assignments Practice Location: 1400 Us Hwy 61, Crystal City, MO 63019 Phone: 636-933-1205 Fax: 636-933-1837 | |
Jennifer Lynne Amptman, Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 508 N Truman Blvd, Upper Level J, Crystal City, MO 63019 Phone: 314-630-2670 Fax: 314-630-2670 |