Provider Demographics
NPI:1336750884
Name:DANIEL, KATHRYN DANIELLE
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:DANIELLE
Last Name:DANIEL
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 1:628 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:PAINTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41240-1471
Mailing Address - Country:US
Mailing Address - Phone:606-789-6966
Mailing Address - Fax:606-789-7466
Practice Address - Street 1:628 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:PAINTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41240-1471
Practice Address - Country:US
Practice Address - Phone:606-789-6966
Practice Address - Fax:606-789-7466
Is Sole Proprietor?:No
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY262282101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)