Provider Demographics
NPI:1699514448
Name:STAHL, DIANA (AMFT)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:STAHL
Suffix:
Gender:U
Credentials:AMFT
Other - Prefix:
Other - First Name:DEAN
Other - Middle Name:
Other - Last Name:STAHL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1633 AMBERWOOD DR APT 25
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-1942
Mailing Address - Country:US
Mailing Address - Phone:626-327-2514
Mailing Address - Fax:
Practice Address - Street 1:4221 WILSHIRE BLVD STE 320
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-3559
Practice Address - Country:US
Practice Address - Phone:323-917-2639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA137070106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist