Healthcare Provider Details

I. General information

NPI: 1780516237
Provider Name (Legal Business Name): DIANE LYNN HANKLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 FERN ST
SANTA CRUZ CA
95060-2117
US

IV. Provider business mailing address

675 VALLEY VIEW RD
BEN LOMOND CA
95005-9385
US

V. Phone/Fax

Practice location:
  • Phone: 831-423-5787
  • Fax:
Mailing address:
  • Phone: 831-254-4577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number22943
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: