Provider Demographics
NPI:1609922905
Name:YOUNG, DIANA (LMFT, PHD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LMFT, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5674 STONERIDGE DR STE 217
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-8532
Mailing Address - Country:US
Mailing Address - Phone:925-927-7200
Mailing Address - Fax:925-227-1253
Practice Address - Street 1:5674 STONERIDGE DR STE 217
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-8532
Practice Address - Country:US
Practice Address - Phone:925-927-7200
Practice Address - Fax:925-227-1253
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-27
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC24260106H00000X
CAPSY25398103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist