Provider Demographics
NPI:1760860688
Name:WEINRICH, DANIEL (PHD, LCPC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:WEINRICH
Suffix:
Gender:M
Credentials:PHD, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1765 CASTELLI DR
Mailing Address - Street 2:
Mailing Address - City:AMMON
Mailing Address - State:ID
Mailing Address - Zip Code:83401-6149
Mailing Address - Country:US
Mailing Address - Phone:208-522-8099
Mailing Address - Fax:
Practice Address - Street 1:1765 CASTELLI DR
Practice Address - Street 2:
Practice Address - City:AMMON
Practice Address - State:ID
Practice Address - Zip Code:83401-6149
Practice Address - Country:US
Practice Address - Phone:208-522-8099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-12
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC #403101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor