Provider Demographics
NPI:1326319898
Name:DIANA R. GALVAN, PLLC
Entity Type:Organization
Organization Name:DIANA R. GALVAN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GOVERNING PERSON
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:R
Authorized Official - Last Name:GALVAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT, LPC
Authorized Official - Phone:210-699-0345
Mailing Address - Street 1:11122 WURZBACH RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-2573
Mailing Address - Country:US
Mailing Address - Phone:210-699-0345
Mailing Address - Fax:210-699-0377
Practice Address - Street 1:11122 WURZBACH RD
Practice Address - Street 2:SUITE 301
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-2573
Practice Address - Country:US
Practice Address - Phone:210-699-0345
Practice Address - Fax:210-699-0377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-15
Last Update Date:2012-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8572101YM0800X, 101YP2500X
TX001346106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0263113-02Medicaid
TX2648392OtherAETNA
TX128640OtherMHN
TX2979LCOtherBLUE CROSS/ BLUE SHIELD