Provider Demographics
NPI:1215034897
Name:MCCOLLUM, DIANE E (MS)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:E
Last Name:MCCOLLUM
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:
Other - Last Name:MCCOLLUM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC, LMFT
Mailing Address - Street 1:9227 E LAKE HIGHLANDS DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-2722
Mailing Address - Country:US
Mailing Address - Phone:214-324-9362
Mailing Address - Fax:
Practice Address - Street 1:4225 OFFICE PKWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-3628
Practice Address - Country:US
Practice Address - Phone:214-821-6505
Practice Address - Fax:214-821-6504
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18464101Y00000X
TX61481101YM0800X
TX5163106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist