Provider Demographics
NPI:1609170349
Name:GARRISON, DANIELLE N (MS, LIMHP, LMHP, LPC)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:N
Last Name:GARRISON
Suffix:
Gender:F
Credentials:MS, LIMHP, LMHP, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14092 HOSPITAL ROAD
Mailing Address - Street 2:
Mailing Address - City:BOYS TOWN
Mailing Address - State:NE
Mailing Address - Zip Code:68010
Mailing Address - Country:US
Mailing Address - Phone:531-355-5460
Mailing Address - Fax:531-355-5499
Practice Address - Street 1:14092 HOSPITAL ROAD
Practice Address - Street 2:
Practice Address - City:BOYS TOWN
Practice Address - State:NE
Practice Address - Zip Code:68010
Practice Address - Country:US
Practice Address - Phone:531-355-5460
Practice Address - Fax:531-355-5499
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-10
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4169101YM0800X
NE9314101YM0800X
NE2047101YP2500X
NE1235101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47076510700Medicaid