Provider Demographics
NPI:1225759004
Name:DANIELS, CLINT JESS (LMFT)
Entity Type:Individual
Prefix:DR
First Name:CLINT
Middle Name:JESS
Last Name:DANIELS
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 SIERRA MADRE VILLA AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-2000
Mailing Address - Country:US
Mailing Address - Phone:626-351-9616
Mailing Address - Fax:
Practice Address - Street 1:650 SIERRA MADRE VILLA AVE STE 110
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-2000
Practice Address - Country:US
Practice Address - Phone:626-351-9616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31208106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist