Individual
MR. GUS TOM DIAMOND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2500 S POWER RD STE 108, MESA, AZ 85209-6687
(480) 981-6089
Mailing address
3134 N 80TH ST, MESA, AZ 85207-9765
(602) 478-9831
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCSW-10267
AZ
Other
Enumeration date
04/06/2007
Last updated
07/08/2007
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