Provider Demographics
NPI:1467711416
Name:DANIELS, JEAN L (PHD)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:L
Last Name:DANIELS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 E MYRTLE AVE
Mailing Address - Street 2:SUITE 405
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-8600
Mailing Address - Country:US
Mailing Address - Phone:423-773-1071
Mailing Address - Fax:
Practice Address - Street 1:112 E MYRTLE AVE
Practice Address - Street 2:SUITE 405
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-8600
Practice Address - Country:US
Practice Address - Phone:423-773-1071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-11
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1580101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional