Provider Demographics
NPI:1275687204
Name:FERNANDEZ-DIAZ, MARIA-JOSE (LMFT)
Entity Type:Individual
Prefix:
First Name:MARIA-JOSE
Middle Name:
Last Name:FERNANDEZ-DIAZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:MARIA JOSE
Other - Middle Name:
Other - Last Name:FERNANDEZ DIAZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2777 N STEMMONS FREEWAY
Mailing Address - Street 2:MAIL STOP ST4.04-BH
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75207
Mailing Address - Country:US
Mailing Address - Phone:844-856-6926
Mailing Address - Fax:
Practice Address - Street 1:1935 MEDICAL DISTRICT DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-7701
Practice Address - Country:US
Practice Address - Phone:844-856-6926
Practice Address - Fax:214-867-5383
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201849106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200440760AMedicaid
11759290OtherCAQH
KS853958OtherBCBS