Provider Demographics
NPI:1811010895
Name:WORDEN, DANIEL KEALY (MFT)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:KEALY
Last Name:WORDEN
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16630 BASS LN
Mailing Address - Street 2:
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-9470
Mailing Address - Country:US
Mailing Address - Phone:530-265-0484
Mailing Address - Fax:530-265-0484
Practice Address - Street 1:995 HELLING WAY
Practice Address - Street 2:
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-8619
Practice Address - Country:US
Practice Address - Phone:530-265-7222
Practice Address - Fax:530-265-9376
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 33805106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist