Basic Information
| Provider Information | |||||||||
| NPI: | 1265000988 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLINE | ||||||||
| FirstName: | DARYL | ||||||||
| MiddleName: | SCOTT | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MSW, CDP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 915 W EMMA AVE | ||||||||
| Address2: | |||||||||
| City: | COEUR D ALENE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838142531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2086651707 | ||||||||
| FaxNumber: | 2086678649 | ||||||||
| Practice Location | |||||||||
| Address1: | 915 W EMMA AVE | ||||||||
| Address2: | |||||||||
| City: | COEUR D ALENE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838142531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2086651707 | ||||||||
| FaxNumber: | 2086678649 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2021 | ||||||||
| LastUpdateDate: | 06/17/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 60416722 | WA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.