Provider Demographics
NPI:1013189000
Name:DIETRICH, MARKUS K (MS)
Entity Type:Individual
Prefix:MR
First Name:MARKUS
Middle Name:K
Last Name:DIETRICH
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 358950
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0371
Mailing Address - Country:US
Mailing Address - Phone:352-246-2717
Mailing Address - Fax:352-378-1828
Practice Address - Street 1:5024 NW 27TH CT
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-6545
Practice Address - Country:US
Practice Address - Phone:352-265-5490
Practice Address - Fax:352-265-5495
Is Sole Proprietor?:No
Enumeration Date:2008-03-31
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH6341101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health