Active NPI
Diane Ellen Kizziar, LPC
- Professional Counselor
- Lewisville, TX
National Provider Identifier
1881286946
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 84358
- Practice address
- 105 Kathryn Dr Ste 230-517
Lewisville, TX 75067-4216 - Phone
- (800) 972-0643
- NPI assigned
- Feb 9, 2021
- 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 | 84358 | TX | Primary |
Addresses
Primary practice location
105 Kathryn Dr Ste 230-517
Lewisville, TX 75067-4216
Mailing address
4576 Saint Samons St
Carrollton, TX 75010-2370
Phone (972) 213-5391
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 15625 | Other | TX | LCDC LICENSE |
| 84358 | Other | TX | STATE LICENSE |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | credentialing@grace-counseling.com | Health Information Exchange (HIE) |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Previously, effective Sep 3, 2024 through Sep 3, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 84358 | TX | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1612828800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1651536000000",
"number": "1881286946",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4576 SAINT SAMONS ST",
"city": "CARROLLTON",
"state": "TX",
"postal_code": "750102370",
"telephone_number": "972-213-5391"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "105 KATHRYN DR STE 230-517",
"city": "LEWISVILLE",
"state": "TX",
"postal_code": "750674216",
"telephone_number": "800-972-0643"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIZZIAR",
"first_name": "DIANE",
"middle_name": "ELLEN",
"name_prefix": "Mrs.",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-02-09",
"last_updated": "2022-05-03",
"certification_date": "2022-05-03",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "TX",
"license": "84358",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LCDC LICENSE",
"identifier": "15625",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "84358",
"state": "TX"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "credentialing@grace-counseling.com",
"affiliation": "N",
"endpointDescription": "email",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "105 Kathryn Dr Ste 230-517",
"city": "Lewisville",
"state": "TX",
"country_code": "US",
"postal_code": "750674216",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Lewisville, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 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.