Provider Demographics
NPI:1720100902
Name:JANSSEN, DIANE EUGENIA (LMFT)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:EUGENIA
Last Name:JANSSEN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 250
Mailing Address - Street 2:
Mailing Address - City:DESCANSO
Mailing Address - State:CA
Mailing Address - Zip Code:91916-0250
Mailing Address - Country:US
Mailing Address - Phone:619-933-3957
Mailing Address - Fax:619-445-3171
Practice Address - Street 1:2065 ALPINE BLVD
Practice Address - Street 2:STE 3
Practice Address - City:ALPINE
Practice Address - State:CA
Practice Address - Zip Code:91901
Practice Address - Country:US
Practice Address - Phone:619-933-3957
Practice Address - Fax:619-445-3171
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC30395106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist