Provider Demographics
NPI:1417692112
Name:DIAZ, LILIANA (PHD)
Entity Type:Individual
Prefix:
First Name:LILIANA
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:LIL
Other - Middle Name:
Other - Last Name:DESHOTELS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:5600 W LOVERS LN STE 307
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75209-4306
Mailing Address - Country:US
Mailing Address - Phone:214-460-1232
Mailing Address - Fax:
Practice Address - Street 1:5600 W LOVERS LN STE 307
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75209-4306
Practice Address - Country:US
Practice Address - Phone:214-460-1232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26865103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent