Provider Demographics
NPI:1841648615
Name:DR. DIANNA TROUTT, MARRIAGE AND FAMILY THERAPIST, INC.
Entity type:Organization
Organization Name:DR. DIANNA TROUTT, MARRIAGE AND FAMILY THERAPIST, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:TROUTT
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:714-423-3533
Mailing Address - Street 1:1151 DOVE ST STE 113
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2805
Mailing Address - Country:US
Mailing Address - Phone:714-423-3533
Mailing Address - Fax:949-552-4422
Practice Address - Street 1:1151 DOVE ST STE 113
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2805
Practice Address - Country:US
Practice Address - Phone:714-423-3533
Practice Address - Fax:949-552-4422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-02
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC30977261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health