Provider Demographics
NPI:1801929534
Name:BROWN, DIANA L (MA MFT)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:L
Last Name:BROWN
Suffix:
Gender:F
Credentials:MA MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3058
Mailing Address - Street 2:
Mailing Address - City:STATELINE
Mailing Address - State:NV
Mailing Address - Zip Code:89449-3058
Mailing Address - Country:US
Mailing Address - Phone:775-588-9407
Mailing Address - Fax:775-588-5458
Practice Address - Street 1:310 DORLA COURT
Practice Address - Street 2:SUITE 201
Practice Address - City:ZEPHYR COVE
Practice Address - State:NV
Practice Address - Zip Code:89448
Practice Address - Country:US
Practice Address - Phone:775-588-9407
Practice Address - Fax:775-588-5458
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0645106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist