Provider Demographics
NPI:1477171080
Name:DANIEL, LISA (CFPSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:DANIEL
Suffix:
Gender:F
Credentials:CFPSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 FIR ST
Mailing Address - Street 2:
Mailing Address - City:T OR C
Mailing Address - State:NM
Mailing Address - Zip Code:87901-1724
Mailing Address - Country:US
Mailing Address - Phone:575-937-2944
Mailing Address - Fax:
Practice Address - Street 1:808 FIR ST
Practice Address - Street 2:
Practice Address - City:T OR C
Practice Address - State:NM
Practice Address - Zip Code:87901-1724
Practice Address - Country:US
Practice Address - Phone:575-937-2944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2011175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist