Provider Demographics
NPI:1447620117
Name:DIEHL, COLTER LYNN (MFTI)
Entity type:Individual
Prefix:
First Name:COLTER
Middle Name:LYNN
Last Name:DIEHL
Suffix:
Gender:M
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 LINCOLN AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-4900
Mailing Address - Country:US
Mailing Address - Phone:707-255-3718
Mailing Address - Fax:707-255-3715
Practice Address - Street 1:1100 LINCOLN AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-4900
Practice Address - Country:US
Practice Address - Phone:707-255-3718
Practice Address - Fax:707-255-3715
Is Sole Proprietor?:No
Enumeration Date:2015-10-06
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85257106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist