Provider Demographics
NPI:1497284798
Name:DIAZ, VICTOR M (LCSW)
Entity Type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:M
Last Name:DIAZ
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2290 W. PIKE BLVD.,SUITE 201-B
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596
Mailing Address - Country:US
Mailing Address - Phone:956-246-4220
Mailing Address - Fax:
Practice Address - Street 1:10065 E MONTE CRISTO RD
Practice Address - Street 2:
Practice Address - City:EDCOUCH
Practice Address - State:TX
Practice Address - Zip Code:78538-2533
Practice Address - Country:US
Practice Address - Phone:956-756-4035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-08
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0158141041C0700X
TX60457171M00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator