Provider Demographics
NPI:1467855577
Name:DANIEL, DESIREE (LPC)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:
Last Name:DANIEL
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 1:136 OLD SAN ANTONIO RD
Mailing Address - Street 2:STE. 401
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-3337
Mailing Address - Country:US
Mailing Address - Phone:830-331-8962
Mailing Address - Fax:830-331-8964
Practice Address - Street 1:136 OLD SAN ANTONIO RD
Practice Address - Street 2:STE. 401
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-3337
Practice Address - Country:US
Practice Address - Phone:830-331-8962
Practice Address - Fax:830-331-8964
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-02
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69540101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health