Provider Demographics
NPI:1396863775
Name:CARLYLE, DIANA LYNN (MFT)
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:LYNN
Last Name:CARLYLE
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 1:1130 LINCOLN WAY STE 1
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-5122
Mailing Address - Country:US
Mailing Address - Phone:530-308-5806
Mailing Address - Fax:530-878-9101
Practice Address - Street 1:1130 LINCOLN WAY STE 1
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-5122
Practice Address - Country:US
Practice Address - Phone:530-308-5806
Practice Address - Fax:530-878-9101
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 44048106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist