Healthcare Provider Details

I. General information

NPI: 1689115271
Provider Name (Legal Business Name): DANIELLE WARREN LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2017
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 DON POLSTON DR
EAGLE LAKE FL
33839-3177
US

IV. Provider business mailing address

PO BOX 1214
EAGLE LAKE FL
33839-1214
US

V. Phone/Fax

Practice location:
  • Phone: 863-286-5755
  • Fax:
Mailing address:
  • Phone: 863-286-5755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number14929
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: