Provider Demographics
NPI:1295868925
Name:REID, DIANE L
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:L
Last Name:REID
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:L
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFDT
Mailing Address - Street 1:PO BOX 1559
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93302-1559
Mailing Address - Country:US
Mailing Address - Phone:661-635-3050
Mailing Address - Fax:661-869-1503
Practice Address - Street 1:3717 MT PINOS WAY
Practice Address - Street 2:STE C D
Practice Address - City:FRAZIEK PARK
Practice Address - State:CA
Practice Address - Zip Code:93225
Practice Address - Country:US
Practice Address - Phone:661-245-0250
Practice Address - Fax:661-245-0252
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC32290106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist