Provider Demographics
NPI:1104835008
Name:FERRALES, DIANE (LMFT)
Entity Type:Individual
Prefix:MISS
First Name:DIANE
Middle Name:
Last Name:FERRALES
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1028 LOWELL RD
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-2544
Mailing Address - Country:US
Mailing Address - Phone:575-642-7390
Mailing Address - Fax:575-377-8374
Practice Address - Street 1:1990 E LOHMAN AVE STE 212
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-3172
Practice Address - Country:US
Practice Address - Phone:575-642-7390
Practice Address - Fax:575-377-8374
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCMF0138391106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM14857375Medicaid