Provider Demographics
NPI:1851902423
Name:STACK, DANIELLE JOSEPHINE (LCPC)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:JOSEPHINE
Last Name:STACK
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 WATER LILY DR
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-7777
Mailing Address - Country:US
Mailing Address - Phone:507-351-5307
Mailing Address - Fax:
Practice Address - Street 1:304 GALLATIN PARK DR UNIT 108
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-7907
Practice Address - Country:US
Practice Address - Phone:406-510-1939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-16
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT38719101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health