Provider Demographics
NPI:1598528291
Name:PALACIO, DIANDRA
Entity Type:Individual
Prefix:
First Name:DIANDRA
Middle Name:
Last Name:PALACIO
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 1:18838 STONE OAK PKWY STE 201
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4179
Mailing Address - Country:US
Mailing Address - Phone:210-384-1254
Mailing Address - Fax:210-610-8371
Practice Address - Street 1:18838 STONE OAK PKWY STE 201
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4179
Practice Address - Country:US
Practice Address - Phone:210-384-1254
Practice Address - Fax:210-610-8371
Is Sole Proprietor?:No
Enumeration Date:2024-02-05
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX89256101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional