Active NPI
Diane Kaye Wilson, LMFT
- Marriage & Family Therapist
- Los Angeles, CA
National Provider Identifier
1124892328
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 102166
- Practice address
- 11845 W Olympic Blvd Ste 705W
Los Angeles, CA 90064-5027 - Phone
- (310) 313-3313
- NPI assigned
- Nov 8, 2023
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 102166 | CA | Primary |
Addresses
Primary practice location
11845 W Olympic Blvd Ste 705W
Los Angeles, CA 90064-5027
Mailing address
3629 Ashwood Ave
Los Angeles, CA 90066-3013
Phone (310) 313-3313
Other practice location 1
3629 Ashwood Ave
Los Angeles, CA 90066-3013
Phone (310) 313-3313
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 5, 2024 through Apr 5, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 102166 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1699401600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1699401600000",
"number": "1124892328",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3629 ASHWOOD AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900663013",
"telephone_number": "310-313-3313"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11845 W OLYMPIC BLVD STE 705W",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900645027",
"telephone_number": "310-313-3313"
}
],
"practiceLocations": [
{
"address_1": "3629 Ashwood Ave",
"address_purpose": "LOCATION",
"city": "Los Angeles",
"state": "CA",
"postal_code": "900663013",
"country_code": "US",
"telephone_number": "310-313-3313",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WILSON",
"first_name": "DIANE",
"middle_name": "KAYE",
"credential": "LMFT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-11-08",
"last_updated": "2023-11-08",
"certification_date": "2023-11-08",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "102166",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2023; 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.