Basic Information
Provider Information | |||||||||
NPI: | 1346648771 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | THERSON | ||||||||
FirstName: | DANIELLE | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | PSYD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 5706 NW 149TH ST | ||||||||
Address2: |   | ||||||||
City: | VANCOUVER | ||||||||
State: | WA | ||||||||
PostalCode: | 986851272 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7206759325 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 2450 S VINE ST | ||||||||
Address2: |   | ||||||||
City: | DENVER | ||||||||
State: | CO | ||||||||
PostalCode: | 802105264 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3038713626 | ||||||||
FaxNumber: | 3038713625 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/17/2014 | ||||||||
LastUpdateDate: | 06/09/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 06/09/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X |   |   | N |   | Behavioral Health & Social Service Providers | Counselor | Mental Health | 103TC0700X | PY60900766 | WA | N |   | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TF0200X | 3101 | OR | N |   | Behavioral Health & Social Service Providers | Psychologist | Forensic | 103TF0200X | PY60900766 | WA | N |   | Behavioral Health & Social Service Providers | Psychologist | Forensic | 103TC0700X | 3101 | OR | Y |   | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.