Provider Demographics
NPI:1316548613
Name:BAXTER, DIANNA (LCSW)
Entity Type:Individual
Prefix:
First Name:DIANNA
Middle Name:
Last Name:BAXTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 W FRONT ST STE 100119
Mailing Address - Street 2:
Mailing Address - City:HUTTO
Mailing Address - State:TX
Mailing Address - Zip Code:78634-4204
Mailing Address - Country:US
Mailing Address - Phone:512-524-6121
Mailing Address - Fax:
Practice Address - Street 1:409 W FRONT ST STE 100119
Practice Address - Street 2:
Practice Address - City:HUTTO
Practice Address - State:TX
Practice Address - Zip Code:78634-4204
Practice Address - Country:US
Practice Address - Phone:512-524-6121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX696151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical