Provider Demographics
NPI:1639961956
Name:PEARL, DANIEL
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:PEARL
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 1:5703 4TH AVE UNIT 982
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98248-4040
Mailing Address - Country:US
Mailing Address - Phone:206-914-3938
Mailing Address - Fax:
Practice Address - Street 1:4201 MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-5532
Practice Address - Country:US
Practice Address - Phone:360-305-3275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACB61682579106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician