Diana W. Coulter, MFT
Individual provider Active NPI Marriage & Family Therapist · San Dimas, CA
NPI 1912927666 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1912927666
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Marriage & Family Therapist 106H00000X
- License
- MFC17759 (CA)
- Practice address
- 1115 Via Verde
San Dimas, CA 91773-4400 - Phone
- (909) 599-8800
- Fax
- (909) 599-6661
- NPI assigned
- Jul 19, 2006
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MFC17759 | CA | MD | Marriage & Family Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | MFC17759 | CA | Yes |
Addresses
Primary practice location
1115 Via Verde
San Dimas, CA 91773-4400
Mailing address
1115 Via Verde
San Dimas, CA 91773-4400
Phone (909) 599-8800
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All providers in San Dimas, CA · Marriage & Family Therapist in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.