Healthcare Provider Details

I. General information

NPI: 1104836865
Provider Name (Legal Business Name): KATHLEEN ANN DANIEL LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 02/22/2022
Certification Date: 02/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 PASO CRESTA
CARMEL VALLEY CA
93924
US

IV. Provider business mailing address

PO BOX 405
CARMEL VALLEY CA
93924-0405
US

V. Phone/Fax

Practice location:
  • Phone: 831-521-6037
  • Fax:
Mailing address:
  • Phone: 831-521-6037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT 41221
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: