Provider Demographics
NPI:1821258120
Name:HURTADO, DIANNA L (LCSW)
Entity Type:Individual
Prefix:
First Name:DIANNA
Middle Name:L
Last Name:HURTADO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3608 PRESTON RD STE 150
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8651
Mailing Address - Country:US
Mailing Address - Phone:469-467-2293
Mailing Address - Fax:469-467-4536
Practice Address - Street 1:3608 PRESTON RD STE 150
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8651
Practice Address - Country:US
Practice Address - Phone:469-467-2293
Practice Address - Fax:469-467-4536
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-11
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX407211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX40721OtherLICENSE