Provider Demographics
NPI:1134644040
Name:PHENIX, DIANE MOYLE (MSW)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:MOYLE
Last Name:PHENIX
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:995 HELLING WAY
Mailing Address - Street 2:
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-8619
Mailing Address - Country:US
Mailing Address - Phone:530-265-7222
Mailing Address - Fax:530-265-9376
Practice Address - Street 1:995 HELLING WAY
Practice Address - Street 2:
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959
Practice Address - Country:US
Practice Address - Phone:530-265-7222
Practice Address - Fax:530-265-9376
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health