Provider Demographics
NPI:1508857608
Name:WAY, MARY DIANE (LPC, LMFT, LCDC)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:DIANE
Last Name:WAY
Suffix:
Gender:F
Credentials:LPC, LMFT, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 BURR OAK LN
Mailing Address - Street 2:
Mailing Address - City:ADKINS
Mailing Address - State:TX
Mailing Address - Zip Code:78101-2606
Mailing Address - Country:US
Mailing Address - Phone:830-216-2263
Mailing Address - Fax:830-216-2263
Practice Address - Street 1:1811 BURR OAK LN
Practice Address - Street 2:
Practice Address - City:ADKINS
Practice Address - State:TX
Practice Address - Zip Code:78101-2606
Practice Address - Country:US
Practice Address - Phone:830-216-2263
Practice Address - Fax:830-216-2263
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-31
Last Update Date:2023-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4667101YA0400X
TX11448101YP2500X
TX002924106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist