Provider Demographics
NPI:1992049779
Name:DIAZ, MARY BYERS (LPC)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:BYERS
Last Name:DIAZ
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 1:1614 JENSON RD
Mailing Address - Street 2:
Mailing Address - City:HACKETT
Mailing Address - State:AR
Mailing Address - Zip Code:72937-4313
Mailing Address - Country:US
Mailing Address - Phone:479-629-1521
Mailing Address - Fax:918-649-3747
Practice Address - Street 1:1614 JENSON RD
Practice Address - Street 2:
Practice Address - City:HACKETT
Practice Address - State:AR
Practice Address - Zip Code:72937-4313
Practice Address - Country:US
Practice Address - Phone:479-629-1521
Practice Address - Fax:918-649-3747
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-19
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional