Provider Demographics
NPI:1356359715
Name:GEHART, DIANE R (PHD, LMFT)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:R
Last Name:GEHART
Suffix:
Gender:F
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 HOOPER AVE
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-7357
Mailing Address - Country:US
Mailing Address - Phone:805-405-8248
Mailing Address - Fax:805-496-3376
Practice Address - Street 1:1337 E THOUSAND OAKS BLVD
Practice Address - Street 2:SUITE 116
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91362-2827
Practice Address - Country:US
Practice Address - Phone:805-405-8248
Practice Address - Fax:805-496-3376
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35626106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist