Active NPI
Diane Broady Wilson, LPC
- Mental Health Counselor
- Amarillo, TX
National Provider Identifier
1881605665
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 16692
- Practice address
- 1411 E Amarillo Blvd
1411 Amarillo Blvd., East, J.O. Wyatt Clinic
Amarillo, TX 79107-5555 - Phone
- (806) 351-7212
- Fax
- (806) 351-7284
- NPI assigned
- Aug 10, 2006
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 16692 | TX | Primary |
| Counselor | 101Y00000X | |||
| Professional Counselor | 101YP2500X |
Addresses
Primary practice location
1411 E Amarillo Blvd
1411 Amarillo Blvd., East, J.O. Wyatt Clinic
Amarillo, TX 79107-5555
Mailing address
1411 E Amarillo Blvd
1411 Amarillo Blvd., East, J.O. Wyatt Clinic
Amarillo, TX 79107-5555
Phone (806) 351-7212
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 144810202 | Medicaid | TX |
Other names 1
- Ms. Diane O'Meara Broady
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 |
|---|---|---|---|
| 16692 | TX | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155168000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1324339200000",
"number": "1881605665",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1411 E AMARILLO BLVD",
"address_2": "1411 AMARILLO BLVD., EAST, J.O. WYATT CLINIC",
"city": "AMARILLO",
"state": "TX",
"postal_code": "791075555",
"telephone_number": "806-351-7212",
"fax_number": "806-351-7284"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1411 E AMARILLO BLVD",
"address_2": "1411 AMARILLO BLVD., EAST, J.O. WYATT CLINIC",
"city": "AMARILLO",
"state": "TX",
"postal_code": "791075555",
"telephone_number": "806-351-7212",
"fax_number": "806-351-7284"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "DIANE",
"middle_name": "BROADY",
"name_prefix": "Mrs.",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-10",
"last_updated": "2011-12-20",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "TX",
"license": "16692",
"primary": true
},
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "144810202",
"state": "TX"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "DIANE",
"last_name": "BROADY",
"middle_name": "O'MEARA",
"prefix": "MS.",
"credential": "M.A., LPC",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Amarillo, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.