Provider Demographics
NPI:1144391467
Name:VINES, DIANE TERESA (LPC)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:TERESA
Last Name:VINES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24410 GLENTHORPE CT
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-4523
Mailing Address - Country:US
Mailing Address - Phone:713-854-6115
Mailing Address - Fax:
Practice Address - Street 1:24410 GLENTHORPE CT
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-4523
Practice Address - Country:US
Practice Address - Phone:713-854-6115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16863101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX151734401Medicaid