Healthcare Provider Details

I. General information

NPI: 1649135104
Provider Name (Legal Business Name): DANIELLE DIAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 W 12TH STREET
SILVER CITY NM
88061
US

IV. Provider business mailing address

4208 N DEBBY DR
SILVER CITY NM
88061-7400
US

V. Phone/Fax

Practice location:
  • Phone: 575-538-6805
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB-2025-0443
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: