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General NPI Number Information
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NPI Number | 1962596825
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Entity Type | Individual
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Provider Name | DANIEL MARK MAKI MA, LMFT, LICSW
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Gender | Male
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 10/28/2021
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Provider Practice Location Address
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Address Line | 222 E SUPERIOR ST STE 302
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City | DULUTH
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State | MN
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Zip | 55802-2277
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Country | US
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Telephone | 218-576-5757
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Fax | 844-576-5767
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Provider Business Mailing Address
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Address Line | PO BOX 161462
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City | DULUTH
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State | MN
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Zip | 55816-1462
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Country | US
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Telephone | 218-576-5757
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Fax | 844-576-5767
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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 | 23948
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 15471
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 999-124
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License Number State | WI
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Taxonomy #4
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1183
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License Number State | MN
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