Provider Demographics
NPI:1154479293
Name:KEUSAL, DANIEL M JR (MS)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:M
Last Name:KEUSAL
Suffix:JR
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 NE 125TH ST
Mailing Address - Street 2:SUITE 112
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-4373
Mailing Address - Country:US
Mailing Address - Phone:206-523-1340
Mailing Address - Fax:
Practice Address - Street 1:2611 NE 125TH ST
Practice Address - Street 2:SUITE 112
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-4373
Practice Address - Country:US
Practice Address - Phone:206-523-1340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00001195106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist