Provider Demographics
NPI:1902536675
Name:BELTRAN, DIANA PINTO (DBH, LPC)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:PINTO
Last Name:BELTRAN
Suffix:
Gender:F
Credentials:DBH, LPC
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:
Other - Last Name:CROCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DBH
Mailing Address - Street 1:2451 MONTARO DR
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85650-1205
Mailing Address - Country:US
Mailing Address - Phone:520-301-8430
Mailing Address - Fax:
Practice Address - Street 1:2451 MONTARO DR
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85650-1205
Practice Address - Country:US
Practice Address - Phone:520-301-8430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-21009101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional