Provider Demographics
NPI:1962596825
Name:MAKI, DANIEL MARK (MA, LMFT, LICSW)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:MARK
Last Name:MAKI
Suffix:
Gender:M
Credentials:MA, LMFT, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 161462
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55816-1462
Mailing Address - Country:US
Mailing Address - Phone:218-576-5757
Mailing Address - Fax:844-576-5767
Practice Address - Street 1:222 E SUPERIOR ST STE 302
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-2277
Practice Address - Country:US
Practice Address - Phone:218-576-5757
Practice Address - Fax:844-576-5767
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN239481041C0700X
AZ15471106H00000X
WI999-124106H00000X
MN1183106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP66835OtherHEALTHPARTNERS
MN566903100Medicaid