MEDICARE: DANIEL DAVID O'LOUGHLIN PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC1900X	Counseling Psychologist	24310	TX

General Provider Information

NPI Number	:	1184777336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL DAVID O'LOUGHLIN PH.D.

Provider Business Mailing Address
First Line	:	311 W SAN ANTONIO ST
Second Line	:
City	:	FREDERICKSBURG
State	:	TX
Zip	:	78624-3726
Country	:	US
Telephone Number	:	830-997-0597
Fax Number	:	830-997-0597

Provider Business Practice Location Address
First Line	:	311 W SAN ANTONIO ST
Second Line	:
City	:	FREDERICKSBURG
State	:	TX
Zip	:	78624-3726
Country	:	US
Telephone Number	:	830-997-0597
Fax Number	:	830-997-0597

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	07/08/2007

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