Healthcare Provider Details

I. General information

NPI: 1639743818
Provider Name (Legal Business Name): DANIEL WYATT SEXTON LMHC, CASAC 2
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2021
Last Update Date: 05/13/2021
Certification Date: 05/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 E MAIN ST
HUNTINGTON NY
11743-2852
US

IV. Provider business mailing address

141 E MAIN ST
HUNTINGTON NY
11743-2852
US

V. Phone/Fax

Practice location:
  • Phone: 631-456-4821
  • Fax: 631-456-4821
Mailing address:
  • Phone: 631-456-4821
  • Fax: 631-456-4821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number36298
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number011342-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: