MEDICARE: DANIELLE ETTER, PLLC

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	101YP2500X	Professional Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1639400690	OTHER	TX	SOLE PROVIDER NPI

General Provider Information

NPI Number	:	1942840616
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DANIELLE ETTER, PLLC

Provider Business Mailing Address
First Line	:	4010 BLUE BONNET BLVD STE 202
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77025-1721
Country	:	US
Telephone Number	:	973-271-8354
Fax Number	:

Provider Business Practice Location Address
First Line	:	4010 BLUE BONNET BLVD STE 202
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77025-1721
Country	:	US
Telephone Number	:	973-271-8354
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PSYCHOTHERAPIST
Name	:	DANIELLE ETTER
Credential	:	MS, LPC
Telephone Number	:	973-271-8354

Provider Enumeration Date	:	01/10/2020
Last Update Date	:	01/10/2020

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