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NPI Code Detail

MEDICARE: JULIE DIAZ LMHP

MEDICARE: JULIE DIAZ LMHP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor3077NE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1023183159
Entity Type Code : Individual
Provider Name (Legal Business Name) : JULIE DIAZ LMHP
Provider Business Mailing Address
First Line : 4485 WESTMINSTER PL
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63108-1812
Country : US
Telephone Number : 314-610-8477
Fax Number : 314-535-6632
Provider Business Practice Location Address
First Line : 8631 DELMAR BLVD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63124-1990
Country : US
Telephone Number : 314-787-5100
Fax Number : 314-754-2800
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/22/2006
Last Update Date : 02/07/2012

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