Provider Demographics
NPI:1568695195
Name:MASULLO, DIANE ELAINE (MS, LPC, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:ELAINE
Last Name:MASULLO
Suffix:
Gender:F
Credentials:MS, LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 PASEO ROBLES
Mailing Address - Street 2:
Mailing Address - City:LAMPASAS
Mailing Address - State:TX
Mailing Address - Zip Code:76550-7600
Mailing Address - Country:US
Mailing Address - Phone:254-338-6286
Mailing Address - Fax:800-516-3152
Practice Address - Street 1:1003 W BUSINESS 190
Practice Address - Street 2:
Practice Address - City:COPPERAS COVE
Practice Address - State:TX
Practice Address - Zip Code:76522-3886
Practice Address - Country:US
Practice Address - Phone:254-547-3040
Practice Address - Fax:800-516-3152
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-31
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63673101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX63673OtherLPC STATE LICENSE TEXAS