Provider Demographics
NPI:1023864923
Name:MAXWELL, DIANA LYNN (LPC ASSOCIATE)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:LYNN
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:LPC ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402A W PALM VALLEY BLVD # 184
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-4237
Mailing Address - Country:US
Mailing Address - Phone:612-239-9982
Mailing Address - Fax:
Practice Address - Street 1:402A W PALM VALLEY BLVD # 184
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-4237
Practice Address - Country:US
Practice Address - Phone:612-239-9982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX90450101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health