Provider Demographics
NPI:1578920302
Name:WHAY, DIANA
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:WHAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 873
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:NM
Mailing Address - Zip Code:87015-0873
Mailing Address - Country:US
Mailing Address - Phone:505-948-4942
Mailing Address - Fax:
Practice Address - Street 1:7 STALLION RD
Practice Address - Street 2:
Practice Address - City:STANLEY
Practice Address - State:NM
Practice Address - Zip Code:87056
Practice Address - Country:US
Practice Address - Phone:505-948-4942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-25
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMT0178141101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health