Provider Demographics
NPI:1154813822
Name:PROCH, DANIELLE C (LMHC, NCC)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:C
Last Name:PROCH
Suffix:
Gender:F
Credentials:LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 E LAKE RD # 280
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-2427
Mailing Address - Country:US
Mailing Address - Phone:888-732-2313
Mailing Address - Fax:
Practice Address - Street 1:334 E LAKE RD # 280
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34685-2427
Practice Address - Country:US
Practice Address - Phone:888-732-2313
Practice Address - Fax:727-228-2271
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-30
Last Update Date:2021-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH16044101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLL18000138775Other1154813822
100314146821Other1154813822