Provider Demographics
NPI:1447762414
Name:MONSOUR, DIANA LYNN (MED, LPC, LCDC)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:LYNN
Last Name:MONSOUR
Suffix:
Gender:F
Credentials:MED, LPC, LCDC
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:LYNN
Other - Last Name:LORBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCDC
Mailing Address - Street 1:8200 DAISY CUTTER XING
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-4764
Mailing Address - Country:US
Mailing Address - Phone:806-632-3888
Mailing Address - Fax:
Practice Address - Street 1:4913 S LOOP 289
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-1630
Practice Address - Country:US
Practice Address - Phone:806-412-4721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-31
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX79082101YP2500X
TX14152101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)