MEDICARE: DIANE F. STROTHER PHD

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	101Y00000X	Counselor
2	103TC0700X	Clinical Psychologist	PSY23159	CA

General Provider Information

NPI Number	:	1245365220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE F. STROTHER PHD

Provider Business Mailing Address
First Line	:	447 N EL MOLINO AVE
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91101-1403
Country	:	US
Telephone Number	:	626-577-8480
Fax Number	:	626-577-8978

Provider Business Practice Location Address
First Line	:	301 N PRAIRIE AVE
Second Line	:	SUITE 612
City	:	INGLEWOOD
State	:	CA
Zip	:	90301-4507
Country	:	US
Telephone Number	:	310-673-8402
Fax Number	:	310-673-8407

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

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	12/10/2009

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Directions to “ DIANE F. STROTHER PHD” Practice Location

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