Healthcare Provider Details

I. General information

NPI: 1124323662
Provider Name (Legal Business Name): DIANE L SELLERS RN, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DIANE L MILLER RN

II. Dates (important events)

Enumeration Date: 01/13/2011
Last Update Date: 11/27/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 W CENTER AVE
VISALIA CA
93291-5911
US

IV. Provider business mailing address

4319 W CROWLEY AVE
VISALIA CA
93291-5305
US

V. Phone/Fax

Practice location:
  • Phone: 559-280-5756
  • Fax:
Mailing address:
  • Phone: 559-733-3830
  • Fax: 559-733-3830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN 197014
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 49484
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: