=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356982656
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THOMAS A DIETZ PMHNP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/08/2019
-----------------------------------------------------
Last Update Date | 12/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2828 LOTUS PARK
-----------------------------------------------------
City | SCHERTZ
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78154-3740
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-239-3009
-----------------------------------------------------
Fax | 210-405-9994
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2828 LOTUS PARK
-----------------------------------------------------
City | SCHERTZ
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78154-3740
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-239-3009
-----------------------------------------------------
Fax | 210-405-9994
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 869587
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------