Provider Demographics
NPI:1467870337
Name:APPLEGATE, DANIEL (LCPC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:APPLEGATE
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 O CONNOR CT
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61821-5521
Mailing Address - Country:US
Mailing Address - Phone:217-402-4071
Mailing Address - Fax:
Practice Address - Street 1:4 O CONNOR CT
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61821-5521
Practice Address - Country:US
Practice Address - Phone:217-402-7071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-28
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180010921101YM0800X
IL178.009838101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional