Provider Demographics
NPI:1548327109
Name:GALVAN, DIANA RODRIGUEZ (LPC LMFT)
Entity type:Individual
Prefix:MS
First Name:DIANA
Middle Name:RODRIGUEZ
Last Name:GALVAN
Suffix:
Gender:F
Credentials:LPC LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11122 WURZBACH RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-2573
Mailing Address - Country:US
Mailing Address - Phone:210-699-0345
Mailing Address - Fax:210-699-0377
Practice Address - Street 1:11122 WURZBACH RD
Practice Address - Street 2:SUITE 301
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-2573
Practice Address - Country:US
Practice Address - Phone:210-699-0345
Practice Address - Fax:210-699-0377
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8572101YM0800X, 101YP2500X
TX1346106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0263113-02Medicaid
TX065174OtherVALUE OPTIONS
TX128640OtherMHN
TX138007000OtherMAGELLAN
TX2648392OtherAETNA
TX2979LCOtherBLUE CROSS BLUE SHIELD