| Doctor Name: | GREGORY M DEITCHLER |
| NPI Number: | 1013196716 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MA L.M.F.T., L.P.C., |
| License Number: | LPC949 |
| Business Practice Address: | 1552 N Crestmont Dr Suite C Meridian, ID - 836422191 |
| Business Phone Number: | 2088871911 |
| Business Fax Number: | |
| Mailing Address: | 1624 E Pratt St, MERIDIAN |
| State: | ID |
| Postal Code: | 836423575 |
| Phone Number: | 2083500330 |
| Fax Number: | |
| NPI Enumeration Date: | 10/30/2007 |
| NPI Last Update Date: | 10/30/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | LPC949 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | ID |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |