=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013011279
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DIANE GALE BLIVEN M. ED.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/11/2006
-----------------------------------------------------
Last Update Date | 03/19/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 MASON ST
-----------------------------------------------------
City | TOMBALL
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77375-4450
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-255-9922
-----------------------------------------------------
Fax | 281-255-9064
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13226 N DECKER DR
-----------------------------------------------------
City | MAGNOLIA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77355-3826
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-415-1528
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 18437
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------