Provider Demographics
NPI:1194037788
Name:BADER, DANIEL M (LCPC, LMFT)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:M
Last Name:BADER
Suffix:
Gender:M
Credentials:LCPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 W HOWARD ST
Mailing Address - Street 2:THIRD FLOOR
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-1675
Mailing Address - Country:US
Mailing Address - Phone:312-742-1742
Mailing Address - Fax:
Practice Address - Street 1:1607 W HOWARD ST
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-1675
Practice Address - Country:US
Practice Address - Phone:312-742-1742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-12
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-002045101YM0800X
IL166-000437106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist