Provider Demographics
NPI:1437586336
Name:HUGHES, DIETRA
Entity Type:Individual
Prefix:
First Name:DIETRA
Middle Name:
Last Name:HUGHES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10906 N 153RD LN
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-5325
Mailing Address - Country:US
Mailing Address - Phone:623-547-6496
Mailing Address - Fax:623-547-6496
Practice Address - Street 1:10906 N 153RD LN
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85379-5325
Practice Address - Country:US
Practice Address - Phone:623-547-6496
Practice Address - Fax:623-547-6496
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-09
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ251SOOOOOX101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional