Healthcare Provider Details

I. General information

NPI: 1356359715
Provider Name (Legal Business Name): DIANE R. GEHART PH.D., LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1337 E THOUSAND OAKS BLVD SUITE 116
THOUSAND OAKS CA
91362-2827
US

IV. Provider business mailing address

531 HOOPER AVE
SIMI VALLEY CA
93065-7357
US

V. Phone/Fax

Practice location:
  • Phone: 805-405-8248
  • Fax: 805-496-3376
Mailing address:
  • Phone: 805-405-8248
  • Fax: 805-496-3376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number35626
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: