Healthcare Provider Details

I. General information

NPI: 1821258120
Provider Name (Legal Business Name): DIANNA L HURTADO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3608 PRESTON RD STE 150
PLANO TX
75093-8651
US

IV. Provider business mailing address

3608 PRESTON RD STE 150
PLANO TX
75093-8651
US

V. Phone/Fax

Practice location:
  • Phone: 469-467-2293
  • Fax: 469-467-4536
Mailing address:
  • Phone: 469-467-2293
  • Fax: 469-467-4536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number40721
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: