Provider Demographics
NPI:1881215077
Name:DIMLER, MACY
Entity type:Individual
Prefix:
First Name:MACY
Middle Name:
Last Name:DIMLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14442 N ROTH CT
Mailing Address - Street 2:
Mailing Address - City:RATHDRUM
Mailing Address - State:ID
Mailing Address - Zip Code:83858-6994
Mailing Address - Country:US
Mailing Address - Phone:701-337-6373
Mailing Address - Fax:
Practice Address - Street 1:118 N 7TH ST STE A13
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2767
Practice Address - Country:US
Practice Address - Phone:208-254-6950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-29
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID8331312101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor