Individual
MR. CLINT T. DIAZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LISAC
Contact information
Practice address
106 E 1ST ST, YUMA, AZ 85364-1450
(928) 341-9199
Mailing address
2199 W 12TH LN, YUMA, AZ 85364-4363
(928) 341-9199
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LISAC-10172
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
913914
AHCCCS
AZ
Enumeration date
09/14/2006
Last updated
07/08/2007
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