Provider Demographics
NPI:1417225038
Name:FEICK-KISTLER, DIANA (LPC)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:FEICK-KISTLER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 INDIANA BLVD
Mailing Address - Street 2:#375
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75226-1520
Mailing Address - Country:US
Mailing Address - Phone:214-597-8977
Mailing Address - Fax:
Practice Address - Street 1:3330 S LANCASTER RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-4531
Practice Address - Country:US
Practice Address - Phone:972-371-6639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-09
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65209101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional