Provider Demographics
NPI:1194390955
Name:BLACK, DANELL TENYENHUIS (LPCC)
Entity Type:Individual
Prefix:
First Name:DANELL
Middle Name:TENYENHUIS
Last Name:BLACK
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2167 SHAW AVE STE 115
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-8935
Mailing Address - Country:US
Mailing Address - Phone:559-930-9475
Mailing Address - Fax:
Practice Address - Street 1:575 E LOCUST AVE STE 101
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2928
Practice Address - Country:US
Practice Address - Phone:559-575-0165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-24
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12727101YM0800X
CA7998101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA12727OtherLPCC LICENSE