Provider Demographics
NPI:1437697703
Name:DANIEL-EDGERTON, DANA (LPC)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:DANIEL-EDGERTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DANA D. EDGERTON, LPC
Mailing Address - Street 2:707 W. 10TH ST.
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-2033
Mailing Address - Country:US
Mailing Address - Phone:512-507-0286
Mailing Address - Fax:
Practice Address - Street 1:DANA D. EDGERTON, LPC
Practice Address - Street 2:707 W. 10TH ST.
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-2033
Practice Address - Country:US
Practice Address - Phone:512-507-0286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-07
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68595101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional