Provider Demographics
NPI:1003956723
Name:KINKEAD, DIANNA MAE (MA, LPC, LMFT)
Entity Type:Individual
Prefix:
First Name:DIANNA
Middle Name:MAE
Last Name:KINKEAD
Suffix:
Gender:F
Credentials:MA, LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 EDENDALE CIR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-6041
Mailing Address - Country:US
Mailing Address - Phone:281-646-7366
Mailing Address - Fax:
Practice Address - Street 1:20915 KINGSLAND BLVD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-5548
Practice Address - Country:US
Practice Address - Phone:281-579-0703
Practice Address - Fax:281-398-9719
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLPC 10510101YP2500X
TXLMFT 536106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist