Basic Information
| Provider Information | |||||||||
| NPI: | 1689612855 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SPURLOCK | ||||||||
| FirstName: | DIANA | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MSW, LCSW, LISW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1050 S 16TH PL | ||||||||
| Address2: | |||||||||
| City: | COTTONWOOD | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 863266993 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9286491802 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 500 N US HIGHWAY 89 | ||||||||
| Address2: | |||||||||
| City: | PRESCOTT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 863135001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009491005 | ||||||||
| FaxNumber: | 9287766125 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LCSW 4157 | AZ | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | LISW I4257 | NM | N | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.