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General NPI Number Information
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NPI Number | 1255455564
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Entity Type | Individual
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Provider Name | DIANA IVORY LMFT
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Gender | Female
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 09/10/2018
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Provider Practice Location Address
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Address Line | 1188 N EUCLID ST STE 500
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City | ANAHEIM
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State | CA
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Zip | 92801-1900
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Country | US
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Telephone | 714-644-6480
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Fax |
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Provider Business Mailing Address
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Address Line | 1107 FAIR OAKS AVE # 85
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City | SOUTH PASADENA
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State | CA
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Zip | 91030-3311
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Country | US
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Telephone | 626-476-6658
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT52532
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | IMF 49008
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License Number State | CA
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