MEDICARE: DAUNTLESS COUNSELING AND CONSULTING LLC

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	101Y00000X	Counselor
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1316694375
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAUNTLESS COUNSELING AND CONSULTING LLC

Provider Business Mailing Address
First Line	:	520 S WALNUT ST # 3126
Second Line	:
City	:	BLOOMINGTON
State	:	IN
Zip	:	47401-4618
Country	:	US
Telephone Number	:	812-502-4100
Fax Number	:

Provider Business Practice Location Address
First Line	:	520 S WALNUT ST # 3126
Second Line	:
City	:	BLOOMINGTON
State	:	IN
Zip	:	47401-4618
Country	:	US
Telephone Number	:	812-502-4100
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BRYAN J SHEPARD
Credential	:	LCSW
Telephone Number	:	812-502-4100

Provider Enumeration Date	:	03/09/2022
Last Update Date	:	03/11/2022

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