MEDICARE: MABEL DIAZ LPC

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	101YM0800X	Mental Health Counselor	87387	TX

General Provider Information

NPI Number	:	1861241358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MABEL DIAZ LPC

Provider Business Mailing Address
First Line	:	707 W FRENCH PL APT 4
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78212-3639
Country	:	US
Telephone Number	:	210-400-8639
Fax Number	:

Provider Business Practice Location Address
First Line	:	707 W FRENCH PL APT 4
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78212-3639
Country	:	US
Telephone Number	:	210-400-8639
Fax Number	:

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

Provider Enumeration Date	:	05/16/2024
Last Update Date	:	05/16/2024

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Directions to “ MABEL DIAZ LPC” Practice Location

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