Provider Demographics
NPI:1053510636
Name:DANIELSON, MARCI M (MS)
Entity Type:Individual
Prefix:
First Name:MARCI
Middle Name:M
Last Name:DANIELSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3350 W AMERICANA TER
Mailing Address - Street 2:SUITE 215
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-2521
Mailing Address - Country:US
Mailing Address - Phone:208-989-0333
Mailing Address - Fax:
Practice Address - Street 1:3350 W AMERICANA TER
Practice Address - Street 2:SUITE 215
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-2521
Practice Address - Country:US
Practice Address - Phone:208-989-0333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLAMFT-4590106H00000X
IDLMFT 4491106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist