Healthcare Provider Details

I. General information

NPI: 1982080008
Provider Name (Legal Business Name): DANIELLE FERA LPC, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2015
Last Update Date: 06/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1278 W US HIGHWAY 40
ODESSA MO
64076
US

IV. Provider business mailing address

1800 COMMUNITY
CLINTON MO
64735-8804
US

V. Phone/Fax

Practice location:
  • Phone: 888-403-1071
  • Fax: 816-633-7942
Mailing address:
  • Phone: 660-885-8131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2015026834
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: