Provider Demographics
NPI:1356524045
Name:DIETZ, VICTOR H (MAPC, JD)
Entity type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:H
Last Name:DIETZ
Suffix:
Gender:M
Credentials:MAPC, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 S PARK BLVD
Mailing Address - Street 2:SUITE # 255
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-6280
Mailing Address - Country:US
Mailing Address - Phone:630-942-8803
Mailing Address - Fax:
Practice Address - Street 1:45 S PARK BLVD
Practice Address - Street 2:SUITE # 255
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-6280
Practice Address - Country:US
Practice Address - Phone:630-942-8803
Practice Address - Fax:630-942-8845
Is Sole Proprietor?:No
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral