Provider Demographics
NPI:1730507914
Name:CASTRO-MOCTEZUMA, DIANA (LMHC, IADC)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:CASTRO-MOCTEZUMA
Suffix:
Gender:
Credentials:LMHC, IADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 5TH ST STE 433
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51101-1507
Mailing Address - Country:US
Mailing Address - Phone:712-560-7045
Mailing Address - Fax:712-454-5951
Practice Address - Street 1:505 5TH ST STE 433
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51101-1507
Practice Address - Country:US
Practice Address - Phone:712-560-7045
Practice Address - Fax:712-454-5951
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-03
Last Update Date:2025-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA12041101YA0400X
IA001675101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)