Provider Demographics
NPI:1023354123
Name:DIAZ, ANNA LEAH (MS, LPC)
Entity type:Individual
Prefix:MS
First Name:ANNA
Middle Name:LEAH
Last Name:DIAZ
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:MS
Other - First Name:ANNA
Other - Middle Name:LEAH
Other - Last Name:SIMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LPCC
Mailing Address - Street 1:PO BOX 382
Mailing Address - Street 2:
Mailing Address - City:DOLORES
Mailing Address - State:CO
Mailing Address - Zip Code:81323-0382
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:37 N MADISON ST
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-3301
Practice Address - Country:US
Practice Address - Phone:970-570-3119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-17
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC0013674101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health