Provider Demographics
NPI:1598973299
Name:VALDEZ, DIANA CAROL (PHD)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:CAROL
Last Name:VALDEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 5TH AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-2919
Mailing Address - Country:US
Mailing Address - Phone:817-332-1425
Mailing Address - Fax:817-338-4707
Practice Address - Street 1:1050 5TH AVE
Practice Address - Street 2:SUITE C
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2919
Practice Address - Country:US
Practice Address - Phone:817-332-1425
Practice Address - Fax:817-338-4707
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19950101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional