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General NPI Number Information
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NPI Number | 1255847422
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Entity Type | Individual
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Provider Name | MICHELLE DIAZ MS, LPC, NCC
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Gender | Female
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Dates
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Enumeration Date | 12/23/2017
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Last Update Date | 12/23/2017
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Provider Practice Location Address
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Address Line | 4209 W SHAMROCK LN
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City | MCHENRY
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State | IL
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Zip | 60050-8700
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Country | US
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Telephone | 815-344-9443
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Fax | 815-344-9445
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Provider Business Mailing Address
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Address Line | 35W735 CRISPIN DR
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City | ELGIN
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State | IL
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Zip | 60123-6724
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Country | US
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Telephone | 224-829-2535
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 178.013346
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License Number State | IL
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