Provider Demographics
NPI:1376793273
Name:MCDANIEL, MILDRED L (LCPC)
Entity Type:Individual
Prefix:
First Name:MILDRED
Middle Name:L
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 486
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83701-0486
Mailing Address - Country:US
Mailing Address - Phone:208-850-4272
Mailing Address - Fax:
Practice Address - Street 1:750 WARM SPRINGS AVE
Practice Address - Street 2:SUITE C
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83712-6475
Practice Address - Country:US
Practice Address - Phone:208-850-4272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-26
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID285101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health