Provider Demographics
NPI:1326052762
Name:LIMA, DAN DENNIS (PHD, MPC, MBA)
Entity Type:Individual
Prefix:
First Name:DAN
Middle Name:DENNIS
Last Name:LIMA
Suffix:
Gender:M
Credentials:PHD, MPC, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 N JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IN
Mailing Address - Zip Code:46041-1936
Mailing Address - Country:US
Mailing Address - Phone:765-659-4771
Mailing Address - Fax:
Practice Address - Street 1:205 N JACKSON ST
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IN
Practice Address - Zip Code:46041-1936
Practice Address - Country:US
Practice Address - Phone:756-659-4771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-29
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39000669A101YM0800X, 101YM0800X
IN33001493A104100000X
IN87000118A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)