Carmen E Diaz, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

4081 De Zavala Rd Ste 201
Shavano Park, TX 78249-2082

Phone

(210) 414-5398

NPI assigned

Apr 9, 2022

Last updated

Jun 1, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 18, 2025 through Jan 18, 2027

Medicare enrollment (NPD)

Not enrolled

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Evolve Wellness Center LLC

  • Clinic/Center
  • Shavano Park, TX
  • NPI 1023751302
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1649462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654041600000",
    "number": "1457093585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4081 DE ZAVALA RD STE 201",
            "city": "SHAVANO PARK",
            "state": "TX",
            "postal_code": "782492082",
            "telephone_number": "210-971-4380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4081 DE ZAVALA RD STE 201",
            "city": "SHAVANO PARK",
            "state": "TX",
            "postal_code": "782492082",
            "telephone_number": "210-414-5398"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIAZ",
        "first_name": "CARMEN",
        "middle_name": "E",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-04-09",
        "last_updated": "2022-06-01",
        "certification_date": "2022-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "TX",
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "TX",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Diabetes and Metabolism Specialists
• Diabetic Foot Ulcer Prevention Strategies, Inc
• Dianne Dental PLLC (Park Hill Dental)
• Diaz Hospitalist Group PLLC
• Carlos Javier Diaz Velez, MD
• Easy River Counseling and Wellness PLLC
• Wilson Irabor Ebhohon
• Eleven Eleven Counseling and Wellness
• Evolve Wellness Center LLC
• Daniela Nazaret Fargason, MD

• Mental Health Counselor in Shavano Park, TX
• Providers in Shavano Park, TX by specialty
• Mental Health Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.