Laura Teresa Diaz, QMHA
Individual provider Active NPI Mental Health Counselor · Medford, OR
NPI 1639893142 · NPPES record last updated Sep 28, 2022
Key facts
- NPI
- 1639893142
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- Practice address
- 200 Beatty St
Medford, OR 97501-5811 - Phone
- (541) 476-2373
- NPI assigned
- Sep 28, 2022
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Yes |
Addresses
Primary practice location
200 Beatty St
Medford, OR 97501-5811
Mailing address
1215 SW G St
Grants Pass, OR 97526-2544
Phone (541) 476-2373
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0823201701 | Medicaid | OR |
Other providers in Medford, OR
- Elena Dflores
- Maritza Diaz Arias
- Alexa Diaz
- Jessica H Diaz
- Jessica Lynn Diaz
- Lauren Diaz
- Charles R Dibb
- Ashley Dicharry
- David Dickinson
- Mercedes Dickinson
All providers in Medford, OR · Mental Health Counselor in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 28, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.