Provider Demographics
NPI:1346266384
Name:MARTINDALE, DIANA SUE (M ED)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:SUE
Last Name:MARTINDALE
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 W 8TH AVE
Mailing Address - Street 2:SUITE 800
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79101-2399
Mailing Address - Country:US
Mailing Address - Phone:806-353-1668
Mailing Address - Fax:806-353-1668
Practice Address - Street 1:112 W 8TH AVE
Practice Address - Street 2:SUITE 800
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79101-2399
Practice Address - Country:US
Practice Address - Phone:806-353-1668
Practice Address - Fax:806-353-1668
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9231101YP2500X
TX42091041C0700X
TX3608106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00S17KMedicare PIN