Provider Demographics
NPI:1285643981
Name:WATERS, DIANA G (PH D)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:G
Last Name:WATERS
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:DR
Other - First Name:DIANA
Other - Middle Name:G
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:13301 N MERIDIAN AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-8357
Mailing Address - Country:US
Mailing Address - Phone:405-752-9500
Mailing Address - Fax:405-752-9571
Practice Address - Street 1:13301 N MERIDIAN AVE STE 100
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8357
Practice Address - Country:US
Practice Address - Phone:405-752-9500
Practice Address - Fax:405-752-9571
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK312103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical