Provider Demographics
NPI:1063634384
Name:RESH, DANIEL J JR (LMHC)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:J
Last Name:RESH
Suffix:JR
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1284
Mailing Address - Street 2:
Mailing Address - City:CAPE CANAVERAL
Mailing Address - State:FL
Mailing Address - Zip Code:32920-1284
Mailing Address - Country:US
Mailing Address - Phone:321-267-2228
Mailing Address - Fax:866-703-0035
Practice Address - Street 1:6700 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780-8050
Practice Address - Country:US
Practice Address - Phone:321-269-4590
Practice Address - Fax:321-268-5689
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2022-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH5490101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL313948Medicaid
FL004939000Medicaid
FL113658100Medicaid
FL293882Medicaid