Provider Demographics
NPI:1679786974
Name:DIAMOND, ROBERT PROCTOR (MA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:PROCTOR
Last Name:DIAMOND
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7592 E PALO VERDE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-3235
Mailing Address - Country:US
Mailing Address - Phone:928-227-2900
Mailing Address - Fax:928-277-1494
Practice Address - Street 1:7592 E PALO VERDE ST
Practice Address - Street 2:SUITE A
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-3235
Practice Address - Country:US
Practice Address - Phone:928-227-2900
Practice Address - Fax:928-277-1494
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0500XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherEEG
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral