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General NPI Number Information
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NPI Number | 1487836565
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Entity Type | Individual
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Provider Name | DANIEL RAY PICKEL LCSW
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Gender | Male
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Dates
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Enumeration Date | 11/30/2007
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Last Update Date | 02/20/2019
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Provider Practice Location Address
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Address Line | 1100 WILFORD HALL LOOP, BLDG 4554 ATTN: 59 MDW/SGHC
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City | JBSA-LACKLAND
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State | TX
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Zip | 78236
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Country | US
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Telephone | 210-292-6225
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 WILFORD HALL LOOP, BLDG 4554 ATTN: 59 MDW/SGHC
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City | JBSA-LACKLAND
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State | TX
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Zip | 78236-9908
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Country | US
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Telephone | 210-292-6225
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 23535
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License Number State | TX
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