Provider Demographics
NPI:1477250918
Name:DISAL, DANA LYNN
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:LYNN
Last Name:DISAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5266 HOLLISTER AVE STE 215
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93111-4041
Mailing Address - Country:US
Mailing Address - Phone:805-284-4901
Mailing Address - Fax:
Practice Address - Street 1:5266 HOLLISTER AVE STE 215
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93111-4041
Practice Address - Country:US
Practice Address - Phone:805-284-4901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35062106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty