Provider Demographics
NPI:1285852608
Name:BIRMINGHAM, DANIEL L (PHD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:L
Last Name:BIRMINGHAM
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:868 NW SOUTH SHORE DR
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-1446
Mailing Address - Country:US
Mailing Address - Phone:816-505-3080
Mailing Address - Fax:
Practice Address - Street 1:868 NW SOUTH SHORE DR
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64151-1446
Practice Address - Country:US
Practice Address - Phone:816-505-3080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00016103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical