Basic Information
| Provider Information | |||||||||
| NPI: | 1982735635 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COLVEN | ||||||||
| FirstName: | DYAN | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | PSY.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1825 IDAHO AVE | ||||||||
| Address2: | |||||||||
| City: | SANTA MONICA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 904033301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108295030 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3321 EDITH ST | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900644736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3102020669 | ||||||||
| FaxNumber: | 3108394158 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PSY14969 | CA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.