MEDICARE: MS. DIANA JANETTE WHITE LMFT

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	MFC 40644	CA

General Provider Information

NPI Number	:	1972612844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DIANA JANETTE WHITE LMFT

Provider Business Mailing Address
First Line	:	4001 60TH ST
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95820-3223
Country	:	US
Telephone Number	:	916-739-1556
Fax Number	:

Provider Business Practice Location Address
First Line	:	7245 E SOUTHGATE DR
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95823-2620
Country	:	US
Telephone Number	:	916-427-7141
Fax Number	:	916-427-7122

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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