Active NPI
Justine Diaz, LPC
- Professional Counselor
- Springfield, MO
National Provider Identifier
1699146654
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 2019021903
- Practice address
- 1300 E Bradford Pkwy
Springfield, MO 65804-4264 - Phone
- (417) 761-5000
- NPI assigned
- Oct 15, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 2019021903 | MO | Primary |
Addresses
Primary practice location
1300 E Bradford Pkwy
Springfield, MO 65804-4264
Mailing address
1300 E Bradford Pkwy
Springfield, MO 65804-4264
Phone (417) 761-5000
Other practice location 1
5360 N Academy Blvd
130
Colorado Springs, CO 80918-4006
Phone (719) 227-7477 ext. 17
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 490094466 | Medicaid | MO |
Other names 1
- Miss Justine Hormell
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2019021903 | MO | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Resource Network | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- Colorado Springs, CO
- NPI 1548430812
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1444867200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658188800000",
"number": "1699146654",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1300 E BRADFORD PKWY",
"city": "SPRINGFIELD",
"state": "MO",
"postal_code": "658044264",
"telephone_number": "417-761-5000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1300 E BRADFORD PKWY",
"city": "SPRINGFIELD",
"state": "MO",
"postal_code": "658044264",
"telephone_number": "417-761-5000"
}
],
"practiceLocations": [
{
"address_1": "5360 N Academy Blvd",
"address_2": "130",
"address_purpose": "LOCATION",
"city": "Colorado Springs",
"state": "CO",
"postal_code": "809184006",
"country_code": "US",
"telephone_number": "719-227-7477 x17",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "DIAZ",
"first_name": "JUSTINE",
"name_prefix": "Mrs.",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-10-15",
"last_updated": "2022-07-19",
"certification_date": "2022-07-19",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MO",
"license": "2019021903",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "490094466",
"state": "MO"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "JUSTINE",
"last_name": "HORMELL",
"prefix": "MISS",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Springfield, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.