MEDICARE: MS. DANIELLE RENEE CONN

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1346394525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DANIELLE RENEE CONN

Provider Business Mailing Address
First Line	:	260 SOUTH ST
Second Line	:
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93401-5007
Country	:	US
Telephone Number	:	805-785-0874
Fax Number	:

Provider Business Practice Location Address
First Line	:	277 SOUTH ST STE Y
Second Line	:
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93401-5039
Country	:	US
Telephone Number	:	805-489-9659
Fax Number	:	805-489-9659

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

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	07/08/2007

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