Provider Demographics
NPI:1346840667
Name:DIEMER, JOHN JUDE (CAS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:JUDE
Last Name:DIEMER
Suffix:
Gender:M
Credentials:CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 CARBON
Mailing Address - Street 2:
Mailing Address - City:TRINIDAD
Mailing Address - State:CO
Mailing Address - Zip Code:81082-3664
Mailing Address - Country:US
Mailing Address - Phone:719-846-4481
Mailing Address - Fax:
Practice Address - Street 1:1004 CARBON
Practice Address - Street 2:
Practice Address - City:TRINIDAD
Practice Address - State:CO
Practice Address - Zip Code:81082-3664
Practice Address - Country:US
Practice Address - Phone:719-846-4481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACB-8628101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)