Provider Demographics
NPI:1013032341
Name:CONLEY, DIANA (MFTI)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:
Last Name:CONLEY
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3855F ALAMO ST STE 2032
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-2109
Mailing Address - Country:US
Mailing Address - Phone:805-582-7507
Mailing Address - Fax:
Practice Address - Street 1:3855F ALAMO ST STE 2032
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-2109
Practice Address - Country:US
Practice Address - Phone:805-582-7507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFTI51105OtherINTERN NUMBER