Provider Demographics
NPI:1376167262
Name:DYESS, DANIEL BRYAN
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:BRYAN
Last Name:DYESS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:296 BEAUVOIR RD STE 100-1311
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-4051
Mailing Address - Country:US
Mailing Address - Phone:228-707-4417
Mailing Address - Fax:228-678-7877
Practice Address - Street 1:6017 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-2648
Practice Address - Country:US
Practice Address - Phone:228-218-1242
Practice Address - Fax:228-678-7877
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-05
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS252001106E00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician