Provider Demographics
NPI:1205188216
Name:DIAZ, DILYSE LOUISE (LMFT)
Entity Type:Individual
Prefix:
First Name:DILYSE
Middle Name:LOUISE
Last Name:DIAZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23734 VALENCIA BLVD STE 306
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-5371
Mailing Address - Country:US
Mailing Address - Phone:661-904-0113
Mailing Address - Fax:
Practice Address - Street 1:23734 VALENCIA BLVD STE 306
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-5371
Practice Address - Country:US
Practice Address - Phone:661-904-0113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37656106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist