Provider Demographics
NPI:1043748734
Name:DIAS, KAYLAN (MFTI)
Entity Type:Individual
Prefix:MS
First Name:KAYLAN
Middle Name:
Last Name:DIAS
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 1:920 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-1204
Mailing Address - Country:US
Mailing Address - Phone:818-242-8403
Mailing Address - Fax:818-242-3187
Practice Address - Street 1:920 E BROADWAY
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-1204
Practice Address - Country:US
Practice Address - Phone:818-242-8403
Practice Address - Fax:818-242-3187
Is Sole Proprietor?:No
Enumeration Date:2017-05-25
Last Update Date:2017-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88058106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist