Healthcare Provider Details

I. General information

NPI: 1861641987
Provider Name (Legal Business Name): DANIEL LLOYD STANLEY LCSW, BCD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2008
Last Update Date: 09/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2861 S NETTLETON AVE #A107
SPRINGFIELD MO
65807-7551
US

IV. Provider business mailing address

2861 S NETTLETON AVE #A107
SPRINGFIELD MO
65807-7551
US

V. Phone/Fax

Practice location:
  • Phone: 417-439-2174
  • Fax:
Mailing address:
  • Phone: 417-439-2174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2007013549
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: