Provider Demographics
NPI:1932293867
Name:HARVEY ANDERSON, DIANE M (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:M
Last Name:HARVEY ANDERSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:DIANE
Other - Middle Name:M
Other - Last Name:HARVEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:12805 CINCHRING LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78727-4534
Mailing Address - Country:US
Mailing Address - Phone:512-659-8553
Mailing Address - Fax:512-331-4103
Practice Address - Street 1:12805 CINCHRING LN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78727-4534
Practice Address - Country:US
Practice Address - Phone:512-659-8553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX228601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX108132502Medicaid
TX108132502Medicaid