Provider Demographics
NPI:1134593049
Name:DANIELS, JUDY
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:DANIELS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1
Mailing Address - Street 2:121 RAPHIEL STREET
Mailing Address - City:CAMPTI
Mailing Address - State:LA
Mailing Address - Zip Code:71411-0001
Mailing Address - Country:US
Mailing Address - Phone:318-238-3197
Mailing Address - Fax:318-238-3199
Practice Address - Street 1:90 NORTH MELROSE STREET
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71411
Practice Address - Country:US
Practice Address - Phone:318-238-3197
Practice Address - Fax:318-238-3199
Is Sole Proprietor?:No
Enumeration Date:2015-11-17
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health