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General NPI Number Information
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NPI Number | 1013196716
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Entity Type | Individual
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Provider Name | GREGORY M DEITCHLER MA L.M.F.T., L.P.C.,
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Gender | Male
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Dates
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Enumeration Date | 10/30/2007
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Last Update Date | 01/28/2019
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Provider Practice Location Address
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Address Line | 3061 S. MERIDIAN RD. SUITE 100
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City | MERIDIAN
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State | ID
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Zip | 83642
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Country | US
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Telephone | 208-350-0330
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Fax | 208-576-6915
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Provider Business Mailing Address
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Address Line | 3061 S. MERIDIAN RD. SUITE 100
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City | MERIDIAN
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State | ID
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Zip | 83642
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Country | US
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Telephone | 208-350-0330
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Fax | 208-576-6915
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC-949
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC949
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT2935
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License Number State | ID
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