MEDICARE: MS. DIANE BIRGIT PROSSER MFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	101YM0800X	CA
2	106H00000X	Marriage & Family Therapist	21767	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	21767	OTHER	CA	BBS
2	N4429037	OTHER	CA	DRIVERS LICENSE NUMBER

General Provider Information

NPI Number	:	1164731964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DIANE BIRGIT PROSSER MFT

Provider Business Mailing Address
First Line	:	5090 N COLLEGE AVE APT 113
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93704-2609
Country	:	US
Telephone Number	:	831-917-7993
Fax Number	:

Provider Business Practice Location Address
First Line	:	5090 N COLLEGE AVE APT 113
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93704-2609
Country	:	US
Telephone Number	:	831-917-7993
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2010
Last Update Date	:	03/13/2026

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