Provider Demographics
NPI:1982952859
Name:WEIGEL, DANIEL (PHD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:WEIGEL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 N. 4TH AVENUE
Mailing Address - Street 2:PMB 4172
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-0609
Mailing Address - Country:US
Mailing Address - Phone:580-745-2632
Mailing Address - Fax:
Practice Address - Street 1:1405 N. 4TH AVENUE
Practice Address - Street 2:PMB 4172
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-0609
Practice Address - Country:US
Practice Address - Phone:580-745-2632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-26
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK211101YA0400X
OK3172101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health