Healthcare Provider Details

I. General information

NPI: 1851870612
Provider Name (Legal Business Name): DESIREE DIAZ MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2018
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4425 E AGAVE RD STE 106
PHOENIX AZ
85044-0620
US

IV. Provider business mailing address

4425 E AGAVE RD STE 106
PHOENIX AZ
85044-0620
US

V. Phone/Fax

Practice location:
  • Phone: 602-830-2004
  • Fax:
Mailing address:
  • Phone: 602-830-2004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-16991
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: