1659651115

Everything you always wanted to know about DIAZ MARIE GINA LMHC but were afraid to ask.

DIAZ MARIE GINA LMHC

You can also download the this 1659651115 data report as csv | excel | json | xml
Provider Last Name Provider Middle Name Provider First Name Provider Credential
DIAZ MARIE GINA LMHC
Gender:
Female
Enumeration date:
2011-08-27
Last update date:
2011-08-27
Current as of:
Is sole proprietor?:
No
Is organization subpart?:
No
In PECOS?:
No
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Identifiers

identifier description issuer state
183447000 Medicaid none IA

Taxonomies

Taxonomy State License Number Primary?
101YM0800X Mental Health IA 350 Y

Phone Numbers

Type Number
Mailing Address Telephone Number 5154918522
Practice Location Address Telephone Number 5154918522

Addresses

Type Address City State Postal Country
Mailing Address 10850 NW 105TH CT GRANGER IA 50109 IA
Practice Location Address 10850 NW 105TH CT GRANGER IA 50109 IA