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General NPI Number Information
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NPI Number | 1285720862
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Entity Type | Individual
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Provider Name | DAVID CLIFFORD DANIEL JR. PH.D.
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Gender | Male
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2495 SHREVEPORT HWY 71N 116B PSYCHOLOGY CLINIC
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City | ALEXANDRIA
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State | LA
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Zip | 71306-9004
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Country | US
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Telephone | 318-473-0010
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Fax | 318-483-5096
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Provider Business Mailing Address
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Address Line | 217 WOODWIND LANE
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City | PINEVILLE
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State | LA
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Zip | 71360-7754
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Country | US
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Telephone | 318-442-8905
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 84-02P
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License Number State | AR
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