MEDICARE: MISS DIANE FERRALES LMFT

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
1	106H00000X	Marriage & Family Therapist	CMF0138391	NM

Other Identifiers

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

General Provider Information

NPI Number	:	1104835008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS DIANE FERRALES LMFT

Provider Business Mailing Address
First Line	:	1028 LOWELL RD
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-2544
Country	:	US
Telephone Number	:	575-642-7390
Fax Number	:	575-377-8374

Provider Business Practice Location Address
First Line	:	1990 E LOHMAN AVE STE 212
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-3172
Country	:	US
Telephone Number	:	575-642-7390
Fax Number	:	575-377-8374

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	07/19/2022

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