MEDICARE: DIANA CAROL VALDEZ PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	19950	TX

General Provider Information

NPI Number	:	1598973299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA CAROL VALDEZ PHD

Provider Business Mailing Address
First Line	:	1050 5TH AVE
Second Line	:	SUITE C
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2919
Country	:	US
Telephone Number	:	817-332-1425
Fax Number	:	817-338-4707

Provider Business Practice Location Address
First Line	:	1050 5TH AVE
Second Line	:	SUITE C
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2919
Country	:	US
Telephone Number	:	817-332-1425
Fax Number	:	817-338-4707

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2007
Last Update Date	:	07/08/2007

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