Provider Demographics
NPI:1902324023
Name:DIEKHOFF, DEANA DANILOVA (LPA)
Entity Type:Individual
Prefix:
First Name:DEANA
Middle Name:DANILOVA
Last Name:DIEKHOFF
Suffix:
Gender:F
Credentials:LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3631 NEW LONDON RD
Mailing Address - Street 2:
Mailing Address - City:HENRIETTA
Mailing Address - State:TX
Mailing Address - Zip Code:76365-7036
Mailing Address - Country:US
Mailing Address - Phone:940-567-1082
Mailing Address - Fax:
Practice Address - Street 1:1101 SCOTT AVE
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-4671
Practice Address - Country:US
Practice Address - Phone:940-761-9700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-08
Last Update Date:2017-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37037103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX08091980OtherNPI