Wilson, Diane Broady

Wilson, Diane Broady is an individual health care provider with primary practice located at 1411 E Amarillo Blvd 1411 Amarillo Blvd., East, J.O. Wyatt Clinic, Amarillo TX 79107-5555. She recently has 3 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Counselor, Behavioral Health & Social Service Providers / Professional. Behavioral Health & Social Service Providers / Mental Health is her primary health care specialty. Wilson, Diane Broady can be contacted via phone (806) 351-7212.

Contact Information

Primary practice address
1411 E Amarillo Blvd 1411 Amarillo Blvd., East, J.O. Wyatt Clinic Amarillo TX 79107-5555
Phone: (806) 351-7212
Fax: (806) 351-7284
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X 16692 Texas
Behavioral Health & Social Service Providers / Counselor 101Y00000X
Behavioral Health & Social Service Providers / Professional 101YP2500X

Profile Details

NPI number 1881605665
LBN Legal business name Wilson, Diane Broady
Credentials Licensed Professional Counselor (LPC)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 10th, 2006
Last updated Dec 20th, 2011 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1881605665 NPPES
Texas MEDICAID 144810202

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