Provider Demographics
NPI:1003400219
Name:MADSEN, DANIEL JAMES (MA, LPCC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:JAMES
Last Name:MADSEN
Suffix:
Gender:M
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 20TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-2508
Mailing Address - Country:US
Mailing Address - Phone:763-498-3683
Mailing Address - Fax:
Practice Address - Street 1:510 1ST AVE N STE 601
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-1697
Practice Address - Country:US
Practice Address - Phone:612-367-6929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-28
Last Update Date:2021-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2210101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health