Provider Demographics
NPI:1053480228
Name:DIAZ, PEGGY ANN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:ANN
Last Name:DIAZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 STAGECOACH TRL STE 220
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-3863
Mailing Address - Country:US
Mailing Address - Phone:448-248-7758
Mailing Address - Fax:281-648-2200
Practice Address - Street 1:151 STAGECOACH TRL STE 220
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-3863
Practice Address - Country:US
Practice Address - Phone:448-248-7758
Practice Address - Fax:281-648-2200
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX195671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00S99WMedicaid
TX87256QMedicaid