MEDICARE: BRIANDA LIZETH DIAZ DE LEON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	61795	TX

General Provider Information

NPI Number	:	1164180303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIANDA LIZETH DIAZ DE LEON

Provider Business Mailing Address
First Line	:	2612 VERANDAH LN APT 932
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76006-2647
Country	:	US
Telephone Number	:	682-298-1569
Fax Number	:

Provider Business Practice Location Address
First Line	:	2612 VERANDAH LN APT 932
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76006-2647
Country	:	US
Telephone Number	:	682-298-1569
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2021
Last Update Date	:	12/06/2021

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