Provider Demographics
NPI:1811121536
Name:CANFIELD, DIANA KAY (MS, LCPC, LPC)
Entity type:Individual
Prefix:MS
First Name:DIANA
Middle Name:KAY
Last Name:CANFIELD
Suffix:
Gender:F
Credentials:MS, LCPC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1051 E PHELPS ST
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-1715
Mailing Address - Country:US
Mailing Address - Phone:208-870-8916
Mailing Address - Fax:
Practice Address - Street 1:1051 E PHELPS ST
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-1715
Practice Address - Country:US
Practice Address - Phone:208-870-8916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-09
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-4864101YP2500X
AZLPC-5571T101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ893728Medicaid