Provider Demographics
NPI:1154070159
Name:SIX, DANIEL ROBERT II
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:ROBERT
Last Name:SIX
Suffix:II
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 1:1421 MORGANTOWN AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-4507
Mailing Address - Country:US
Mailing Address - Phone:304-904-3759
Mailing Address - Fax:
Practice Address - Street 1:1421 MORGANTOWN AVE APT 1
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-4507
Practice Address - Country:US
Practice Address - Phone:304-904-3759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-18
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV617101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional