Provider Demographics
NPI:1184972325
Name:DANIELS, ETHEL (MFT)
Entity type:Individual
Prefix:MS
First Name:ETHEL
Middle Name:
Last Name:DANIELS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 E OCEAN BLVD
Mailing Address - Street 2:400B
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-5012
Mailing Address - Country:US
Mailing Address - Phone:562-987-3535
Mailing Address - Fax:562-983-7367
Practice Address - Street 1:600 E OCEAN BLVD
Practice Address - Street 2:400B
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-5012
Practice Address - Country:US
Practice Address - Phone:562-987-3535
Practice Address - Fax:562-983-7367
Is Sole Proprietor?:No
Enumeration Date:2012-08-20
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46613106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1053628719OtherGROUP NPI