Provider Demographics
NPI:1659672525
Name:DANIELS, GINA (MS)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:DANIELS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 ROBERTS RD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:MN
Mailing Address - Zip Code:55313-2269
Mailing Address - Country:US
Mailing Address - Phone:763-291-3031
Mailing Address - Fax:763-657-0819
Practice Address - Street 1:311 BRIGHTON AVE S
Practice Address - Street 2:SUITE B
Practice Address - City:BUFFALO
Practice Address - State:MN
Practice Address - Zip Code:55313-2312
Practice Address - Country:US
Practice Address - Phone:763-291-3031
Practice Address - Fax:763-657-0819
Is Sole Proprietor?:No
Enumeration Date:2010-11-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN101Y00000X, 101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health