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General NPI Number Information
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NPI Number | 1922116078
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Entity Type | Individual
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Provider Name | LISA DANIEL LPC
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Gender | Female
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Dates
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Enumeration Date | 08/28/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 10710 OLD HIGHWAY 64
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City | BOLIVAR
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State | TN
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Zip | 38008-3587
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Country | US
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Telephone | 731-658-6113
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Fax | 731-658-6165
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Provider Business Mailing Address
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Address Line | 735 ANDERSON RD
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City | MOSCOW
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State | TN
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Zip | 38057-8709
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Country | US
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Telephone | 731-658-6113
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Fax | 731-658-6165
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | LPC 671
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License Number State | TN
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