Provider Demographics
NPI:1477748978
Name:DEAN, DIANNA L (LPC)
Entity Type:Individual
Prefix:
First Name:DIANNA
Middle Name:L
Last Name:DEAN
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 1:416 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75021-2822
Mailing Address - Country:US
Mailing Address - Phone:903-465-6344
Mailing Address - Fax:903-465-5943
Practice Address - Street 1:416 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75021-2822
Practice Address - Country:US
Practice Address - Phone:903-465-6344
Practice Address - Fax:903-465-5943
Is Sole Proprietor?:No
Enumeration Date:2007-09-08
Last Update Date:2007-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16757101YP2500X
OK3066101YP2500X
TX26213104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX029086803Medicaid