Provider Demographics
NPI:1356445951
Name:KEARLEY, DANIEL OWEN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:OWEN
Last Name:KEARLEY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1433 FAIRFIELD DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-7244
Mailing Address - Country:US
Mailing Address - Phone:512-491-8444
Mailing Address - Fax:512-491-0226
Practice Address - Street 1:1433 FAIRFIELD DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-7244
Practice Address - Country:US
Practice Address - Phone:512-491-8444
Practice Address - Fax:512-491-0226
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS141471041C0700X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8725B9Medicare PIN
TXR59177Medicare UPIN