Healthcare Provider Details

I. General information

NPI: 1467356675
Provider Name (Legal Business Name): NISHIKIE DIANA GLADNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2026
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 N FM 3083 RD W
CONROE TX
77304-4556
US

IV. Provider business mailing address

6314 NORTHLAND DR
HOUSTON TX
77084-1698
US

V. Phone/Fax

Practice location:
  • Phone: 346-406-9966
  • Fax:
Mailing address:
  • Phone: 346-406-9966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number114690
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: