Provider Demographics
NPI:1427202563
Name:HOLDER, DIANA L (LVN, LCDC, RMT)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:L
Last Name:HOLDER
Suffix:
Gender:F
Credentials:LVN, LCDC, RMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 TEXOMA TER
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-9322
Mailing Address - Country:US
Mailing Address - Phone:903-464-9380
Mailing Address - Fax:903-465-5943
Practice Address - Street 1:13 TEXOMA TER
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-9322
Practice Address - Country:US
Practice Address - Phone:903-464-9380
Practice Address - Fax:903-465-5943
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-14
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX998101YA0400X
TX43718164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No164X00000XNursing Service ProvidersLicensed Vocational Nurse