Healthcare Provider Details

I. General information

NPI: 1386194405
Provider Name (Legal Business Name): DANIEL IMMEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2016
Last Update Date: 12/14/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 CLEVELAND AVE NW
CANTON OH
44702-1805
US

IV. Provider business mailing address

625 CLEVELAND AVE NW
CANTON OH
44702-1805
US

V. Phone/Fax

Practice location:
  • Phone: 330-453-8252
  • Fax: 330-453-6716
Mailing address:
  • Phone: 330-453-8252
  • Fax: 330-453-6716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLDCDIII.161325
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: