Healthcare Provider Details

I. General information

NPI: 1053772624
Provider Name (Legal Business Name): DINAH DZIOLEK LPC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2016
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

623 STATE HIGHWAY 46 E
BOERNE TX
78006-5757
US

IV. Provider business mailing address

522 MYSTIC PKWY
SPRING BRANCH TX
78070-5285
US

V. Phone/Fax

Practice location:
  • Phone: 888-623-8890
  • Fax: 844-654-0224
Mailing address:
  • Phone: 888-623-8890
  • Fax: 844-654-0224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberT-0179831
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2021049363
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-20797
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number80062
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: