Provider Demographics
NPI:1982843777
Name:BINGHAM, DANIEL SHAUN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:SHAUN
Last Name:BINGHAM
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3135 S STATE ST STE 108
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-1653
Mailing Address - Country:US
Mailing Address - Phone:734-369-3180
Mailing Address - Fax:
Practice Address - Street 1:3135 S STATE ST STE 108
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-1653
Practice Address - Country:US
Practice Address - Phone:734-369-3180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-18
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007832103TC0700X
MI6301015753103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical