Provider Information for 1124892328
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DIANE KAYE WILSON LMFT
Sex: Female
NPI: 1124892328
Last Updated: 2023-11-08
Certification Date: 2023-11-08
Certification Date: 2023-11-08
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1124892328 | ||||||||
| Enumeration Date | 2023-11-08 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 3629 ASHWOOD AVE LOS ANGELES, CA 90066-3013 United States Phone: 310-313-3313 | Fax: | ||||||||
| Primary Practice Address | 11845 W OLYMPIC BLVD STE 705W LOS ANGELES, CA 90064-5027 United States Phone: 310-313-3313 | Fax: | ||||||||
| Secondary Practice Address(es) | 3629 ASHWOOD AVE | ||||||||
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