# DIANE PARK MD LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1972847903
- **Authorized official:** DIANE PARK MD (OWNER)
- **Authorized official phone:** (480) 204-2477

## Contact information

- **Practice address:** 1845 S DOBSON RD, SUITE 109, MESA, AZ 85202-5661
- **Practice address phone:** (480) 204-2477
- **Mailing address:** 1845 S DOBSON RD, SUITE 109, MESA, AZ 85202-5661
- **Mailing address phone:** (480) 204-2477

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | 32107 | AZ | Yes |

## Other

- **Enumeration date:** 11/15/2012
- **Last updated:** 11/15/2012