Provider Demographics
NPI:1700344439
Name:MCDANIEL, AMBER (BA, AAC, CPC)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:BA, AAC, CPC
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:MCDANIEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BA, AAC, CPC
Mailing Address - Street 1:209 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531-4245
Mailing Address - Country:US
Mailing Address - Phone:360-520-7056
Mailing Address - Fax:
Practice Address - Street 1:209 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-4245
Practice Address - Country:US
Practice Address - Phone:360-520-7056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-12
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60839871101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health