Basic Information
| Provider Information | |||||||||
| NPI: | 1083863047 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MUMFORD | ||||||||
| FirstName: | DANIELLE | ||||||||
| MiddleName: | LOUISE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MS, MFTI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2513 YOUNGSTOWN RD | ||||||||
| Address2: | |||||||||
| City: | TURLOCK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953809707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2096670327 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2513 YOUNGSTOWN RD | ||||||||
| Address2: | |||||||||
| City: | TURLOCK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953809707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2097252125 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2008 | ||||||||
| LastUpdateDate: | 12/29/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 83277 | CA | N | Behavioral Health & Social Service Providers | Counselor | Professional | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 106H00000X | 83277 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.