Provider Demographics
NPI:1386454569
Name:DIAZ, KARLA MARIE (MA, LPCC)
Entity type:Individual
Prefix:
First Name:KARLA
Middle Name:MARIE
Last Name:DIAZ
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6545 KALUA RD APT 302
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-5813
Mailing Address - Country:US
Mailing Address - Phone:787-422-6876
Mailing Address - Fax:
Practice Address - Street 1:9201 W 44TH AVE
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-3084
Practice Address - Country:US
Practice Address - Phone:720-551-4269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-10
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0022975101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional