Provider Demographics
NPI:1326160268
Name:MCDANIEL, PAUL R (D MIN)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:R
Last Name:MCDANIEL
Suffix:
Gender:M
Credentials:D MIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10412 ALLISONVILLE RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-2033
Mailing Address - Country:US
Mailing Address - Phone:317-578-9200
Mailing Address - Fax:317-578-9201
Practice Address - Street 1:10412 ALLISONVILLE RD
Practice Address - Street 2:SUITE 105
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-2033
Practice Address - Country:US
Practice Address - Phone:317-578-9200
Practice Address - Fax:317-578-9201
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39000618A101YM0800X
IN34002600A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health