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General NPI Number Information
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NPI Number | 1477646586
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Entity Type | Individual
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Provider Name | DAPHNE LYNN DEMARIS MA
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Gender | Female
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 08/22/2023
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Provider Practice Location Address
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Address Line | 11207 CEDAR POINTE DR S
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City | MINNETONKA
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State | MN
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Zip | 55305-2983
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Country | US
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Telephone | 586-202-0474
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Fax | 651-457-4955
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Provider Business Mailing Address
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Address Line | 11207 CEDAR POINTE DR S
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City | MINNETONKA
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State | MN
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Zip | 55305-2983
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Country | US
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Telephone | 586-202-0474
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Fax | 651-457-4955
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | CC6348
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 136
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6401007055
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | CC00889
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License Number State | MN
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