Provider Demographics
NPI:1700505484
Name:METTEER, DANIELLE KAY (LADC)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:KAY
Last Name:METTEER
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22031 320TH ST
Mailing Address - Street 2:
Mailing Address - City:SEBEKA
Mailing Address - State:MN
Mailing Address - Zip Code:56477-2376
Mailing Address - Country:US
Mailing Address - Phone:701-368-9613
Mailing Address - Fax:
Practice Address - Street 1:4851 STACY ANN DR NW
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-0009
Practice Address - Country:US
Practice Address - Phone:218-308-8600
Practice Address - Fax:218-308-6438
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN305702101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)