Individual
GINA MARIE DIAZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMHC
Contact information
Practice address
10850 NW 105TH CT, GRANGER, IA 50109-9630
(515) 491-8522
Mailing address
10850 NW 105TH CT, GRANGER, IA 50109-9630
(515) 491-8522
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
350
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
183447000
—
IA
Enumeration date
08/27/2011
Last updated
08/27/2011
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