Provider Demographics
NPI:1790230258
Name:NOTTER, DANIEL (MA)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:NOTTER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38442 JONATHAN ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-1846
Mailing Address - Country:US
Mailing Address - Phone:248-705-0356
Mailing Address - Fax:
Practice Address - Street 1:3693 HIDDEN FOREST DR
Practice Address - Street 2:
Practice Address - City:ORION
Practice Address - State:MI
Practice Address - Zip Code:48359-1473
Practice Address - Country:US
Practice Address - Phone:248-705-0356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-24
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401019390101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor