Provider Demographics
NPI:1043402209
Name:DIAZ, MARY LINDA (PHD, LPC)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:LINDA
Last Name:DIAZ
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4642 OSO PKWY
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-5269
Mailing Address - Country:US
Mailing Address - Phone:361-850-7131
Mailing Address - Fax:
Practice Address - Street 1:4642 OSO PKWY
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-5269
Practice Address - Country:US
Practice Address - Phone:361-739-2113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61026101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health