Provider Demographics
NPI:1780876169
Name:SLAP, DIANE KAY (MFT)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:KAY
Last Name:SLAP
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BLANKEN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94134-2407
Mailing Address - Country:US
Mailing Address - Phone:415-330-5740
Mailing Address - Fax:415-330-9120
Practice Address - Street 1:100 BLANKEN AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94134-2407
Practice Address - Country:US
Practice Address - Phone:415-330-5740
Practice Address - Fax:415-330-9120
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT41167106H00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist