Provider Demographics
NPI:1265163869
Name:HERTEL, DANIEL GIFFORD (LAC, LCSW)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:GIFFORD
Last Name:HERTEL
Suffix:
Gender:M
Credentials:LAC, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3580 W ARIZONA AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80219-3905
Mailing Address - Country:US
Mailing Address - Phone:720-354-0047
Mailing Address - Fax:
Practice Address - Street 1:6655 W JEWELL AVE STE 205
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80232-7108
Practice Address - Country:US
Practice Address - Phone:720-354-0047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-23
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACD.0002101101YA0400X
COCSW.099304431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty