Provider Demographics
NPI:1659548592
Name:MINTER, DAISY (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAISY
Middle Name:
Last Name:MINTER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8260 LONGLEAF DR BLDG G
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-1322
Mailing Address - Country:US
Mailing Address - Phone:166-918-2629
Mailing Address - Fax:
Practice Address - Street 1:8260 LONGLEAF DR BLDG G
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-1322
Practice Address - Country:US
Practice Address - Phone:916-691-8262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY26292103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic