Provider Demographics
NPI:1073943957
Name:MICKEY, DANEA (LPC)
Entity Type:Individual
Prefix:
First Name:DANEA
Middle Name:
Last Name:MICKEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5333 EVERHART RD
Mailing Address - Street 2:#206A
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-4866
Mailing Address - Country:US
Mailing Address - Phone:361-225-3885
Mailing Address - Fax:888-680-2764
Practice Address - Street 1:5333 EVERHART RD
Practice Address - Street 2:#206A
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4866
Practice Address - Country:US
Practice Address - Phone:361-225-3885
Practice Address - Fax:888-680-2764
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-14
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69124101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional