Provider Demographics
NPI:1043480411
Name:DIAMOND, KRISTEN LESLIE (PHD)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:LESLIE
Last Name:DIAMOND
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5224 SUN MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-5680
Mailing Address - Country:US
Mailing Address - Phone:817-706-8575
Mailing Address - Fax:817-430-3604
Practice Address - Street 1:105 KATHRYN DR
Practice Address - Street 2:SUITE #800
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-4216
Practice Address - Country:US
Practice Address - Phone:817-706-8575
Practice Address - Fax:817-430-3604
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-02
Last Update Date:2008-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61953103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling