Provider Demographics
NPI:1912782954
Name:DIAZ AYALA, ANA DELLY (MH MHC, LPC)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:DELLY
Last Name:DIAZ AYALA
Suffix:
Gender:F
Credentials:MH MHC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 N MAIN ST LOT 45
Mailing Address - Street 2:
Mailing Address - City:LA FERIA
Mailing Address - State:TX
Mailing Address - Zip Code:78559-6044
Mailing Address - Country:US
Mailing Address - Phone:787-423-0050
Mailing Address - Fax:
Practice Address - Street 1:1201 N MAIN ST LOT 45
Practice Address - Street 2:
Practice Address - City:LA FERIA
Practice Address - State:TX
Practice Address - Zip Code:78559-6044
Practice Address - Country:US
Practice Address - Phone:939-417-8637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86075101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional