Healthcare Provider Details

I. General information

NPI: 1851234967
Provider Name (Legal Business Name): DANIELLE MAE BECKNELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DANIE M BECKNELL LCSW, LCACA

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5105 S US HWY 41 PMB 205
TERRE HAUTE IN
47802
US

IV. Provider business mailing address

5105 S US HWY 41 PMB 205
TERRE HAUTE IN
47802
US

V. Phone/Fax

Practice location:
  • Phone: 636-358-3823
  • Fax:
Mailing address:
  • Phone: 636-358-3823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number87900107A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34012754A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: