Provider Demographics
NPI:1245002179
Name:DANIELS, DANIELLE LYNN (PSYD, LP, LADC)
Entity type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:LYNN
Last Name:DANIELS
Suffix:
Gender:F
Credentials:PSYD, LP, LADC
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 43
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55440-0043
Mailing Address - Country:US
Mailing Address - Phone:612-262-1166
Mailing Address - Fax:612-262-4258
Practice Address - Street 1:20795 KEOKUK AVE
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-6004
Practice Address - Country:US
Practice Address - Phone:952-428-0200
Practice Address - Fax:952-428-0399
Is Sole Proprietor?:No
Enumeration Date:2023-10-24
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP6969103TC1900X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling