Provider Demographics
NPI:1164596938
Name:MCDANIEL, GERALD DOUGLAS (LPC)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:DOUGLAS
Last Name:MCDANIEL
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 S SOUTH ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GLOBE
Mailing Address - State:AZ
Mailing Address - Zip Code:85501-1868
Mailing Address - Country:US
Mailing Address - Phone:928-402-0013
Mailing Address - Fax:928-402-0015
Practice Address - Street 1:1450 S SOUTH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:GLOBE
Practice Address - State:AZ
Practice Address - Zip Code:85501-1868
Practice Address - Country:US
Practice Address - Phone:928-402-0013
Practice Address - Fax:928-402-0015
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC 10631101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional