Provider Demographics
NPI:1780398933
Name:DIAMOND M COUNSELING PLLC
Entity type:Organization
Organization Name:DIAMOND M COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MALLORY
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:STOVER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC-S
Authorized Official - Phone:512-964-4663
Mailing Address - Street 1:2650 COUNTY ROAD 450
Mailing Address - Street 2:
Mailing Address - City:THRALL
Mailing Address - State:TX
Mailing Address - Zip Code:76578-8749
Mailing Address - Country:US
Mailing Address - Phone:512-964-4663
Mailing Address - Fax:
Practice Address - Street 1:2650 COUNTY ROAD 450
Practice Address - Street 2:
Practice Address - City:THRALL
Practice Address - State:TX
Practice Address - Zip Code:76578-8749
Practice Address - Country:US
Practice Address - Phone:512-964-4663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)