Provider Demographics
NPI:1609836394
Name:DANIEL, DIANE M (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:M
Last Name:DANIEL
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3350 AMERICANA TERRACE STE 300
Mailing Address - Street 2:COUNSELING AND PSYCHOLOGICAL SERVICES
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706
Mailing Address - Country:US
Mailing Address - Phone:208-343-1113
Mailing Address - Fax:208-343-0042
Practice Address - Street 1:3350 AMERICANA TERRACE STE 300
Practice Address - Street 2:COUNSELING AND PSYCHOLOGICAL SERVICES
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706
Practice Address - Country:US
Practice Address - Phone:208-343-1113
Practice Address - Fax:208-343-0042
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID376101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional