Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 61953 | TX |
NPI | 1043480411 |
---|---|
Provider Name | Kristen Leslie Diamond |
First Address | Flower Mound, TX 75022-5680 |
Second Address | Lewisville, TX 75067-4216 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2008 |
Last Update Date | 02/03/2008 |