Provider Demographics
NPI:1215200225
Name:DANIEL, LISA M (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:DANIEL
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 ADVENTURELAND DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:ALTOONA
Mailing Address - State:IA
Mailing Address - Zip Code:50009-2237
Mailing Address - Country:US
Mailing Address - Phone:515-202-8763
Mailing Address - Fax:515-957-3380
Practice Address - Street 1:1625 ADVENTURELAND DR
Practice Address - Street 2:SUITE B
Practice Address - City:ALTOONA
Practice Address - State:IA
Practice Address - Zip Code:50009-2237
Practice Address - Country:US
Practice Address - Phone:515-202-8763
Practice Address - Fax:515-957-3380
Is Sole Proprietor?:No
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-11-8318103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst