Provider Demographics
NPI:1205011350
Name:DIAMOND, GARRY LYNN (MFT)
Entity Type:Individual
Prefix:MS
First Name:GARRY
Middle Name:LYNN
Last Name:DIAMOND
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12917 APPLETON WAY
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-2234
Mailing Address - Country:US
Mailing Address - Phone:310-391-4088
Mailing Address - Fax:
Practice Address - Street 1:12917 APPLETON WAY
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-2234
Practice Address - Country:US
Practice Address - Phone:310-391-4088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 28368106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist