| Doctor Name: | MRS. DIANE BROADY WILSON |
| NPI Number: | 1881605665 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPC |
| License Number: | |
| Business Practice Address: | 1411 E Amarillo Blvd 1411 Amarillo Blvd., East, J.o. Wyatt Clinic Amarillo, TX - 791075555 |
| Business Phone Number: | 8063517212 |
| Business Fax Number: | 8063517284 |
| Mailing Address: | 1411 E Amarillo Blvd, 1411 Amarillo Blvd., East, J.o. Wyatt Clinic AMARILLO |
| State: | TX |
| Postal Code: | 791075555 |
| Phone Number: | 8063517212 |
| Fax Number: | 8063517284 |
| NPI Enumeration Date: | 08/10/2006 |
| NPI Last Update Date: | 12/20/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101Y00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |