Provider Demographics
NPI:1982886305
Name:DANIEL, L RENEE (LCSW, LAC)
Entity Type:Individual
Prefix:MS
First Name:L RENEE
Middle Name:
Last Name:DANIEL
Suffix:
Gender:F
Credentials:LCSW, LAC
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:RENEE
Other - Last Name:HERSHEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1555 NE 3RD ST
Mailing Address - Street 2:SUITE B-4 PMB 352
Mailing Address - City:PRINEVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97754-2925
Mailing Address - Country:US
Mailing Address - Phone:541-420-9162
Mailing Address - Fax:
Practice Address - Street 1:528 SE 4TH ST
Practice Address - Street 2:
Practice Address - City:PRINEVILLE
Practice Address - State:OR
Practice Address - Zip Code:97754-2331
Practice Address - Country:US
Practice Address - Phone:541-420-9162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-27
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL41061041C0700X
ORAC01271171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical