Provider Demographics
NPI:1790548360
Name:DANIEL, KEVIN LEE (MA)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:LEE
Last Name:DANIEL
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 1:2509 HOLLY LAUREL MNR
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-5186
Mailing Address - Country:US
Mailing Address - Phone:936-581-7233
Mailing Address - Fax:
Practice Address - Street 1:2509 HOLLY LAUREL MNR
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-5186
Practice Address - Country:US
Practice Address - Phone:936-581-7233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX94179101YP2500X
TX205375106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional