Provider Demographics
NPI:1356982656
Name:DIETZ, THOMAS A (PMHNP)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:A
Last Name:DIETZ
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 360
Mailing Address - Street 2:
Mailing Address - City:SCHERTZ
Mailing Address - State:TX
Mailing Address - Zip Code:78154-0360
Mailing Address - Country:US
Mailing Address - Phone:210-239-3009
Mailing Address - Fax:210-405-9994
Practice Address - Street 1:PO BOX 360
Practice Address - Street 2:
Practice Address - City:SCHERTZ
Practice Address - State:TX
Practice Address - Zip Code:78154-0360
Practice Address - Country:US
Practice Address - Phone:210-239-3009
Practice Address - Fax:210-405-9994
Is Sole Proprietor?:No
Enumeration Date:2019-10-08
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX869587363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health