Provider Demographics
NPI:1013011279
Name:BLIVEN, DIANE GALE (M ED)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:GALE
Last Name:BLIVEN
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:
Other - Last Name:MCELMURRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:13226 N DECKER DR
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77355-3826
Mailing Address - Country:US
Mailing Address - Phone:281-415-1528
Mailing Address - Fax:
Practice Address - Street 1:500 MASON ST
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-4450
Practice Address - Country:US
Practice Address - Phone:281-255-9922
Practice Address - Fax:281-255-9064
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18437101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX168231201Medicaid