MEDICARE: MARCI M DANIELSON M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	LAMFT-4590	ID
2	106H00000X	Marriage & Family Therapist	LMFT 4491	ID

General Provider Information

NPI Number	:	1053510636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCI M DANIELSON M.S.

Provider Business Mailing Address
First Line	:	3350 W AMERICANA TER
Second Line	:	SUITE 215
City	:	BOISE
State	:	ID
Zip	:	83706-2521
Country	:	US
Telephone Number	:	208-989-0333
Fax Number	:

Provider Business Practice Location Address
First Line	:	3350 W AMERICANA TER
Second Line	:	SUITE 215
City	:	BOISE
State	:	ID
Zip	:	83706-2521
Country	:	US
Telephone Number	:	208-989-0333
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2007
Last Update Date	:	05/09/2012

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