Provider Demographics
NPI:1790993798
Name:BACHICHA, DANIEL L (PHD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:L
Last Name:BACHICHA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18700 WYNNFIELD RD
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55347-1066
Mailing Address - Country:US
Mailing Address - Phone:952-949-2564
Mailing Address - Fax:952-937-2128
Practice Address - Street 1:18700 WYNNFIELD RD
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55347-1066
Practice Address - Country:US
Practice Address - Phone:952-949-2564
Practice Address - Fax:952-937-2128
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN00165101YP2500X
NM0406101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional