Provider Demographics
NPI:1720480841
Name:NORRBOM, DANIEL MARTIN (MS, CPC-I, LADC, NCC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:MARTIN
Last Name:NORRBOM
Suffix:
Gender:M
Credentials:MS, CPC-I, LADC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10597 CHADWICK FALLS ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89179-1511
Mailing Address - Country:US
Mailing Address - Phone:702-461-0394
Mailing Address - Fax:
Practice Address - Street 1:10597 CHADWICK FALLS ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89179-1511
Practice Address - Country:US
Practice Address - Phone:702-461-0394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-19
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV00280101YA0400X
NVCI0179101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health