Provider Demographics
NPI:1518219948
Name:LEE, DIANA DY AN (MFT INTERN)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:DY AN
Last Name:LEE
Suffix:
Gender:F
Credentials:MFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 W OLYMPIC BLVD STE 550
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-1474
Mailing Address - Country:US
Mailing Address - Phone:213-553-1850
Mailing Address - Fax:213-383-3146
Practice Address - Street 1:605 W OLYMPIC BLVD STE 550
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-1474
Practice Address - Country:US
Practice Address - Phone:213-553-1850
Practice Address - Fax:213-383-3146
Is Sole Proprietor?:No
Enumeration Date:2012-10-09
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF71239106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist