Provider Demographics
NPI:1063990976
Name:COALSON, DIANE LAVERNE (PHD, LP)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:LAVERNE
Last Name:COALSON
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16803 TURKEY POINT ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-1828
Mailing Address - Country:US
Mailing Address - Phone:210-490-2632
Mailing Address - Fax:
Practice Address - Street 1:16803 TURKEY POINT ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-1828
Practice Address - Country:US
Practice Address - Phone:210-490-2632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-02
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37428103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical