Provider Demographics
NPI:1508645847
Name:DANIELS, SALLY (LPC-S)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:DANIELS
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 PRIVATE ROAD 4882
Mailing Address - Street 2:
Mailing Address - City:AZLE
Mailing Address - State:TX
Mailing Address - Zip Code:76020-8844
Mailing Address - Country:US
Mailing Address - Phone:817-556-1762
Mailing Address - Fax:
Practice Address - Street 1:141 W MAIN ST
Practice Address - Street 2:
Practice Address - City:AZLE
Practice Address - State:TX
Practice Address - Zip Code:76020-3117
Practice Address - Country:US
Practice Address - Phone:817-556-1762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
TX16717101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health