Provider Demographics
NPI:1205406816
Name:DIAZ, CESAR AMILCAR (LCDC, LPC)
Entity Type:Individual
Prefix:MR
First Name:CESAR
Middle Name:AMILCAR
Last Name:DIAZ
Suffix:
Gender:M
Credentials:LCDC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4245 KEMP BLVD STE 720
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-2833
Mailing Address - Country:US
Mailing Address - Phone:940-613-1661
Mailing Address - Fax:940-228-0424
Practice Address - Street 1:4245 KEMP BLVD STE 720
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-2833
Practice Address - Country:US
Practice Address - Phone:940-613-1661
Practice Address - Fax:940-228-0424
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-26
Last Update Date:2021-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX82888101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional