Basic Information
| Provider Information | |||||||||
| NPI: | 1134593049 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DANIELS | ||||||||
| FirstName: | JUDY | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1 | ||||||||
| Address2: | 121 RAPHIEL STREET | ||||||||
| City: | CAMPTI | ||||||||
| State: | LA | ||||||||
| PostalCode: | 714110001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182383197 | ||||||||
| FaxNumber: | 3182383199 | ||||||||
| Practice Location | |||||||||
| Address1: | 90 NORTH MELROSE STREET | ||||||||
| Address2: | |||||||||
| City: | NATCHITOCHES | ||||||||
| State: | LA | ||||||||
| PostalCode: | 71411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182383197 | ||||||||
| FaxNumber: | 3182383199 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2015 | ||||||||
| LastUpdateDate: | 11/17/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.