Provider Demographics
NPI:1982735635
Name:COLVEN, DYAN ELIZABETH (PSYD)
Entity Type:Individual
Prefix:
First Name:DYAN
Middle Name:ELIZABETH
Last Name:COLVEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 IDAHO AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-3301
Mailing Address - Country:US
Mailing Address - Phone:310-829-5030
Mailing Address - Fax:
Practice Address - Street 1:3321 EDITH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-4736
Practice Address - Country:US
Practice Address - Phone:310-202-0669
Practice Address - Fax:310-839-4158
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14969103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical