Provider Demographics
NPI:1861748048
Name:DE LARA, DIANA
Entity type:Individual
Prefix:MS
First Name:DIANA
Middle Name:
Last Name:DE LARA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1432 NW 105TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-5116
Mailing Address - Country:US
Mailing Address - Phone:405-413-9092
Mailing Address - Fax:
Practice Address - Street 1:1432 NW 105TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-5116
Practice Address - Country:US
Practice Address - Phone:405-413-9092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-25
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional