Provider Demographics
NPI:1356685614
Name:DIETZEL, JANIS LYNN (M ED, LPC-S)
Entity Type:Individual
Prefix:MS
First Name:JANIS
Middle Name:LYNN
Last Name:DIETZEL
Suffix:
Gender:F
Credentials:M ED, LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1263 MARTINDALE FALLS RD
Mailing Address - Street 2:
Mailing Address - City:MARTINDALE
Mailing Address - State:TX
Mailing Address - Zip Code:78655-2529
Mailing Address - Country:US
Mailing Address - Phone:832-247-3341
Mailing Address - Fax:
Practice Address - Street 1:1263 MARTINDALE FALLS RD
Practice Address - Street 2:
Practice Address - City:MARTINDALE
Practice Address - State:TX
Practice Address - Zip Code:78655-2529
Practice Address - Country:US
Practice Address - Phone:832-247-3341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63148101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional