Provider Demographics
NPI:1073732996
Name:SPACH, DANIEL L
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:L
Last Name:SPACH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 COUNTY HOSPITAL RD STE 109
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:CA
Mailing Address - Zip Code:95971-9126
Mailing Address - Country:US
Mailing Address - Phone:530-283-6307
Mailing Address - Fax:530-283-6045
Practice Address - Street 1:270 COUNTY HOSPITAL RD STE 109
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:CA
Practice Address - Zip Code:95971-9126
Practice Address - Country:US
Practice Address - Phone:530-283-6307
Practice Address - Fax:530-283-6045
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA120765106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health