Provider Demographics
NPI:1578991501
Name:MANSFIELD, DANIELLE ELAINE (LCSW)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:ELAINE
Last Name:MANSFIELD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:ELAINE
Other - Last Name:LASTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:4822 KEMP BLVD STE 500A
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-5271
Mailing Address - Country:US
Mailing Address - Phone:940-374-6408
Mailing Address - Fax:940-733-9260
Practice Address - Street 1:4822 KEMP BLVD STE 500A
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-5271
Practice Address - Country:US
Practice Address - Phone:940-374-6408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-30
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11731101YA0400X
TX396941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)