Provider Demographics
NPI:1962411546
Name:TATEM, DIANE W (LPC)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:W
Last Name:TATEM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6020 TORREY PINES DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-2030
Mailing Address - Country:US
Mailing Address - Phone:915-433-5034
Mailing Address - Fax:915-584-1904
Practice Address - Street 1:4141 PINNACLE ST
Practice Address - Street 2:SUITE 218
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-1059
Practice Address - Country:US
Practice Address - Phone:915-544-5020
Practice Address - Fax:914-544-5020
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5647101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2474LCOtherBCBS PROVIDER NO.
TX35503OtherMAGELLAN PROVDER NO.