Provider Demographics
NPI:1407819469
Name:DANNER, GARIN (LMHC)
Entity Type:Individual
Prefix:MR
First Name:GARIN
Middle Name:
Last Name:DANNER
Suffix:
Gender:M
Credentials:LMHC
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 4244
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14852-4244
Mailing Address - Country:US
Mailing Address - Phone:607-339-7825
Mailing Address - Fax:845-230-6662
Practice Address - Street 1:319 N TIOGA ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-4205
Practice Address - Country:US
Practice Address - Phone:607-339-7825
Practice Address - Fax:845-230-6662
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000304101YM0800X
TX15536101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX028006701Medicaid