Provider Demographics
NPI:1255849568
Name:WORLEY, DIANA LEE (L M F T)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:LEE
Last Name:WORLEY
Suffix:
Gender:F
Credentials:L M F T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31640 US HIGHWAY 19 N STE 2
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-3738
Mailing Address - Country:US
Mailing Address - Phone:615-512-2178
Mailing Address - Fax:
Practice Address - Street 1:31640 US HIGHWAY 19 N STE 2
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3738
Practice Address - Country:US
Practice Address - Phone:615-512-2178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-21
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT4248106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist