Provider Demographics
NPI:1427363639
Name:DIAZ, TYLER MARIN (LMFT 86361)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:MARIN
Last Name:DIAZ
Suffix:
Gender:F
Credentials:LMFT 86361
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 W SHAW AVE STE 116
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-3412
Mailing Address - Country:US
Mailing Address - Phone:559-385-5734
Mailing Address - Fax:559-224-4288
Practice Address - Street 1:2350 W SHAW AVE STE 116
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711
Practice Address - Country:US
Practice Address - Phone:559-385-5734
Practice Address - Fax:559-224-4288
Is Sole Proprietor?:No
Enumeration Date:2010-08-11
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86361101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health