Provider Demographics
NPI:1144577248
Name:MENDEZ, DIANA MARIE (MS, CRC, LPC)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:MARIE
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:MS, CRC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 W FREDDY GONZALEZ DR APT 31
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-5303
Mailing Address - Country:US
Mailing Address - Phone:956-245-6009
Mailing Address - Fax:956-683-1119
Practice Address - Street 1:1418 BEECH AVE
Practice Address - Street 2:SUITE 117A
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-5193
Practice Address - Country:US
Practice Address - Phone:956-245-6009
Practice Address - Fax:956-683-1119
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66515101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional