Individual
DIANE SLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4606 FM 563 RD, LIBERTY, TX 77575-9247
(512) 298-8167
Mailing address
3918 E HIGHWAY 90, LIBERTY, TX 77575-8854
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
76170
TX
Other
Enumeration date
01/13/2026
Last updated
01/13/2026
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