Provider Demographics
NPI:1619362282
Name:CARROLL, DANIEL ALLAN (LMFT)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:ALLAN
Last Name:CARROLL
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16551 VICTORY BLVD APT 220
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-5668
Mailing Address - Country:US
Mailing Address - Phone:818-256-5351
Mailing Address - Fax:
Practice Address - Street 1:20951 BURBANK BLVD STE D
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-6696
Practice Address - Country:US
Practice Address - Phone:818-256-5351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-31
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104858106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist