Healthcare Provider Details

I. General information

NPI: 1275263824
Provider Name (Legal Business Name): ELISSA DANIEL MS.,LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2022
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 E ENTERPRISE AVE STE 333
APPLETON WI
54913-7889
US

IV. Provider business mailing address

2800 E ENTERPRISE AVE STE 333
APPLETON WI
54913-7889
US

V. Phone/Fax

Practice location:
  • Phone: 414-381-5910
  • Fax:
Mailing address:
  • Phone: 414-381-5910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5361226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: