Provider Demographics
NPI:1811232168
Name:PUCCETTI, DIANA L (LPC)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:L
Last Name:PUCCETTI
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:LAMAR
Other - Last Name:PUCCETTI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:401 N LAURELWOOD DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78733-3160
Mailing Address - Country:US
Mailing Address - Phone:512-656-4812
Mailing Address - Fax:
Practice Address - Street 1:401 N LAURELWOOD DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78733-3160
Practice Address - Country:US
Practice Address - Phone:512-656-4812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-27
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14618101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional