Individual provider Active NPI

Dianna Nickel, LPC

  • Counselor
  • Flower Mound, TX
National Provider Identifier
1669851762
Registry record updated Aug 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
Practice address
2620 Long Prairie Rd Ste 100
Flower Mound, TX 75022-4953
Phone
(817) 240-0012
NPI assigned
May 21, 2015
Last updated
Aug 30, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 30, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X NU Primary

Addresses

Primary practice location

2620 Long Prairie Rd Ste 100
Flower Mound, TX 75022-4953

Mailing address

1617 Fieldstone Dr
Little Elm, TX 75068-6440
Phone (469) 237-6100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240918003224 TX Practitioner - Mental Health Counselor 9638610595 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Blank Slate TherapyGroup PAC ID 5193069219, 17 clinicians

Practice addresses (Care Compare)

8751 Collin McKinney Pkwy
Suite 502
McKinney, TX 75070-1853
Phone (214) 618-0588

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Blank Slate Therapy CurrentSince Aug 1, 2024 Accepting new patients
Braindocs PastSince Sep 1, 2024 Accepting new patients

Locations

5899 Preston Rd
Ste 404
Frisco, TX 75034
Phone (214) 618-0588

4400 State Highway 121
Ste 208
Lewisville, TX 75056
Phone (214) 618-0588

8751 Collin McKinney Pkwy
Ste 502
McKinney, TX 75070
Phone (214) 308-1665

185 S Kimball Ave
Ste 120
Southlake, TX 76092
Phone (214) 618-0588

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1432166400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724976000000",
    "number": "1669851762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1617 FIELDSTONE DR",
            "city": "LITTLE ELM",
            "state": "TX",
            "postal_code": "750686440",
            "telephone_number": "469-237-6100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2620 LONG PRAIRIE RD STE 100",
            "city": "FLOWER MOUND",
            "state": "TX",
            "postal_code": "750224953",
            "telephone_number": "817-240-0012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICKEL",
        "first_name": "DIANNA",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-05-21",
        "last_updated": "2024-08-30",
        "certification_date": "2024-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Flower Mound, TX

Sources for this page

Verify at the official NPI Registry.