Provider Demographics
NPI:1689137903
Name:DANIELS, KIMBERLY KAY (BHUS, DP-C)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:KAY
Last Name:DANIELS
Suffix:
Gender:F
Credentials:BHUS, DP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1480 N M 52 STE A
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-1290
Mailing Address - Country:US
Mailing Address - Phone:989-723-8239
Mailing Address - Fax:989-723-8230
Practice Address - Street 1:1480 N M 52 STE A
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-1290
Practice Address - Country:US
Practice Address - Phone:989-723-8239
Practice Address - Fax:989-723-8230
Is Sole Proprietor?:No
Enumeration Date:2019-04-12
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1720314008Medicaid