Individual ProviderTeresa 'Terry' DiakCounselorBehavioral Health & Social Service ProvidersPractice Address505 Eichenfeld Drive, Suite #106, Brandon, FL 33511-5985(813) 689-1895PECOS EnrollmentBased on the most recent information from CMS, provider Teresa 'Terry' Diak does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 11:06 AM.Profile DetailsProvider ID1629321484Provider TypeIndividualFull NameDiak, Teresa 'Terry'TitleMs.CredentialLMHCGenderFemaleSole ProprietorNoEnumeration Date10/18/2012Last Updated10/18/2012Contact InformationPractice LocationPractice Address505 Eichenfeld Drive, Suite #106, Brandon, FL 33511-5985Phone(813) 689-1895Fax(813) 689-4328Mailing LocationMailing Address505 Eichenfeld Drive, Suite #106, Brandon, FL 33511-5985Phone(813) 689-1895Fax(813) 689-4328Provider TaxonomiesCodeDescriptionLicenseCode101YM0800XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseMH4191FloridaProvider IdentifiersIDDescriptionIssuerIDZ050TDescriptionOtherIssuerBLUE CROSS, BLUE SHIELD OUT-OF-NETWORK PROVIDER NUMBERFlorida