Healthcare Provider Details

I. General information

NPI: 1093967549
Provider Name (Legal Business Name): DANIELLE NANCE PSYD, LMHC, CSAYC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2008
Last Update Date: 08/10/2020
Certification Date: 08/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6067 DECATUR BLVD
INDIANAPOLIS IN
46241-9606
US

IV. Provider business mailing address

131 N PENDLETON AVE SUITE A
PENDLETON IN
46064-1076
US

V. Phone/Fax

Practice location:
  • Phone: 317-856-5201
  • Fax: 317-856-2333
Mailing address:
  • Phone: 765-778-3223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39001629A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20042498A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: