MEDICARE: DIANA FIELDER LPC, LMFT

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	09038	TX

General Provider Information

NPI Number	:	1942366091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA FIELDER LPC, LMFT

Provider Business Mailing Address
First Line	:	1616 S KENTUCKY ST
Second Line	:	SUITE C-252
City	:	AMARILLO
State	:	TX
Zip	:	79102-2252
Country	:	US
Telephone Number	:	806-350-7898
Fax Number	:	806-350-7899

Provider Business Practice Location Address
First Line	:	1616 S KENTUCKY ST
Second Line	:	SUITE C-252
City	:	AMARILLO
State	:	TX
Zip	:	79102-2252
Country	:	US
Telephone Number	:	806-350-7898
Fax Number	:	806-350-7899

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

Provider Enumeration Date	:	12/30/2006
Last Update Date	:	07/08/2007

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