Provider Demographics
NPI:1851870612
Name:DIAZ, DESIREE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:657 W BAYLOR LN
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-8215
Mailing Address - Country:US
Mailing Address - Phone:505-730-5952
Mailing Address - Fax:
Practice Address - Street 1:8700 E VIA DE VENTURA STE 280
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4541
Practice Address - Country:US
Practice Address - Phone:480-210-7266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-12
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-16991101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional