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General NPI Number Information
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NPI Number | 1457885824
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Entity Type | Individual
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Provider Name | MEGAN GUILLEN DIAZ
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Gender | Female
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Dates
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Enumeration Date | 04/12/2017
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Last Update Date | 05/21/2021
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Provider Practice Location Address
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Address Line | 12482 W RAMBLIN ROSE DR
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City | BOISE
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State | ID
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Zip | 83713-0011
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Country | US
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Telephone | 208-273-9521
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Fax |
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Provider Business Mailing Address
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Address Line | 784 S CLEARWATER LOOP STE R
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City | POST FALLS
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State | ID
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Zip | 83854-9599
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Country | US
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Telephone |
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Fax |
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 8128
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License Number State | ID
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