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General NPI Number Information
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NPI Number | 1184136202
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Entity Type | Individual
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Provider Name | DIANA GRUBB M.ED.
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Gender | Female
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Dates
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Enumeration Date | 10/30/2017
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Last Update Date | 01/10/2023
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Provider Practice Location Address
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Address Line | 185 S WHITE CHAPEL BLVD
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City | SOUTHLAKE
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State | TX
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Zip | 76092-7308
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Country | US
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Telephone | 817-552-2129
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Fax |
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Provider Business Mailing Address
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Address Line | 6409 ROYAL CT
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City | NORTH RICHLAND HILLS
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State | TX
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Zip | 76180-8080
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Country | US
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Telephone | 972-489-7726
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 70811
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License Number State | TX
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