Provider Demographics
NPI:1982319919
Name:HOOLEY, DANIEL MARTIN (LPC LCPC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:MARTIN
Last Name:HOOLEY
Suffix:
Gender:M
Credentials:LPC LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9700 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:STAR
Mailing Address - State:ID
Mailing Address - Zip Code:83669-5766
Mailing Address - Country:US
Mailing Address - Phone:503-887-5168
Mailing Address - Fax:
Practice Address - Street 1:9700 W STATE ST
Practice Address - Street 2:
Practice Address - City:STAR
Practice Address - State:ID
Practice Address - Zip Code:83669-5766
Practice Address - Country:US
Practice Address - Phone:503-887-5168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-13
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC6944101YP2500X
IDLCPC-9153101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID15810840OtherCAQH