Provider Demographics
NPI:1942955976
Name:FISHER, DIANE RENE (LMFT)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:RENE
Last Name:FISHER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 EGRET LN
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-1760
Mailing Address - Country:US
Mailing Address - Phone:949-235-4711
Mailing Address - Fax:
Practice Address - Street 1:1400 QUAIL ST STE 255
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2714
Practice Address - Country:US
Practice Address - Phone:949-415-4710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-17
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA126826106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist