MEDICARE: KRISTA DIEHL

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1659088771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTA DIEHL

Provider Business Mailing Address
First Line	:	9575 PLAYER CT
Second Line	:
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-3352
Country	:	US
Telephone Number	:	847-436-5916
Fax Number	:

Provider Business Practice Location Address
First Line	:	9575 PLAYER CT
Second Line	:
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-3352
Country	:	US
Telephone Number	:	847-436-5916
Fax Number	:

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

Provider Enumeration Date	:	10/28/2022
Last Update Date	:	10/28/2022

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Directions to “ KRISTA DIEHL ” Practice Location

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