Provider Demographics
NPI:1255076154
Name:DESMOND, DANIEL (BHT)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:DESMOND
Suffix:
Gender:M
Credentials:BHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 S ELIZABETH WAY APT 2048
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-5694
Mailing Address - Country:US
Mailing Address - Phone:602-570-5883
Mailing Address - Fax:
Practice Address - Street 1:250 S ELIZABETH WAY APT 2048
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-5694
Practice Address - Country:US
Practice Address - Phone:602-570-5883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-04
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician