MRS. DIANE BROADY WILSON LPC NPI 1881605665

NPI Information

NPI: 1881605665
Provider Name: MRS. DIANE BROADY WILSON, LPC
Classification: Counselor - 101YM0800X
Entity Type: Individual

Specialization: Mental Health

Address:
1411 E AMARILLO BLVD
1411 AMARILLO BLVD., EAST, J.O. WYATT CLINIC
AMARILLO, TX
ZIP 79107
Phone: (806) 351-7212
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MRS. Diane Broady Wilson, LPC is a mental health counselor in Amarillo, TX. MRS. Diane Broady Wilson, LPC NPI is 1881605665. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

1411 E AMARILLO BLVD
1411 AMARILLO BLVD., EAST, J.O. WYATT CLINIC
AMARILLO, TX
ZIP 79107-555
Phone: (806) 351-7212
Fax: (806) 351-7284

The enumeration date for this NPI number is 8/10/2006 and was last updated on 12/20/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101Y00000X	Counselor				No
2	101YP2500X	Counselor	Professional			No
3	101YM0800X	Counselor	Mental Health	16692	TEXAS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	144810202	MEDICAID	TEXAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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