Provider Demographics
NPI:1093120172
Name:MUNCY, DIANA L (LMFT)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:L
Last Name:MUNCY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:
Other - Last Name:BETZ MUNCY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:301 N MOUNT SHASTA BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:MOUNT SHASTA
Mailing Address - State:CA
Mailing Address - Zip Code:96067
Mailing Address - Country:US
Mailing Address - Phone:530-918-3491
Mailing Address - Fax:530-265-5600
Practice Address - Street 1:301 N MOUNT SHASTA BLVD STE 2
Practice Address - Street 2:
Practice Address - City:MOUNT SHASTA
Practice Address - State:CA
Practice Address - Zip Code:96067
Practice Address - Country:US
Practice Address - Phone:530-918-3491
Practice Address - Fax:530-265-5600
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-26
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health