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General NPI Number Information
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NPI Number | 1578335196
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Entity Type | Individual
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Provider Name | DANIEL JACOB SELF MA, LMHCA
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Gender | Male
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Dates
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Enumeration Date | 10/26/2023
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Last Update Date | 10/26/2023
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Provider Practice Location Address
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Address Line | 30 DONGAN PL APT 6G
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City | NEW YORK
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State | NY
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Zip | 10040-1556
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Country | US
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Telephone | 929-256-2140
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Fax |
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Provider Business Mailing Address
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Address Line | 608 FLATHEAD RIVER ST
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City | OXNARD
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State | CA
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Zip | 93036-5308
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Country | US
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Telephone | 661-674-9564
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MC61409994
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License Number State | WA
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