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NPI Code Detail

MEDICARE: MRS. DIANA L PALS M. ED.

MEDICARE: MRS. DIANA L PALS M. ED.
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
1101YP2500XProfessional CounselorLCPC -167ID

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1137333137335OTHERIDPREMERA BLUE CROSS
2000010015830OTHERIDREGENCE BLUE SHIELD
3Q107-5OTHERIDBLUE CROSS OF IDAHO

General Provider Information

NPI Number : 1396762043
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. DIANA L PALS M. ED.
Provider Business Mailing Address
First Line : 814 S WASHINGTON ST
Second Line :
City : MOSCOW
State : ID
Zip : 83843-3049
Country : US
Telephone Number : 208-883-0619
Fax Number : 208-882-4774
Provider Business Practice Location Address
First Line : 814 S WASHINGTON ST
Second Line :
City : MOSCOW
State : ID
Zip : 83843-3049
Country : US
Telephone Number : 208-883-0619
Fax Number : 208-882-4774
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2006
Last Update Date : 07/08/2007

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Directions to “ MRS. DIANA L PALS M. ED.” Practice Location

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