Provider Demographics
NPI:1437490026
Name:SHEEN, DANIEL T (MA)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:T
Last Name:SHEEN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 N RICHARD PRYOR PL
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61605-2484
Mailing Address - Country:US
Mailing Address - Phone:309-671-8084
Mailing Address - Fax:309-671-8088
Practice Address - Street 1:130 N RICHARD PRYOR PL
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61605-2484
Practice Address - Country:US
Practice Address - Phone:309-671-8084
Practice Address - Fax:309-671-8088
Is Sole Proprietor?:No
Enumeration Date:2013-03-07
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180003823101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health