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
State | License ID | Taxonomies |
---|---|---|
IN | 39000669A | 101YM0800X, 101YM0800X |
IN | 33001493A | 104100000X |
IN | 87000118A | 101YA0400X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | |
No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |