Basic Information
| Provider Information | |||||||||
| NPI: | 1629558069 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DANIEWICZ | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | THOMAS | ||||||||
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| Credential: | MA LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1645 NW EASTBROOK CT | ||||||||
| Address2: | |||||||||
| City: | BEAVERTON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970063252 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033075834 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9670 SW BEAVERTON HILLSDALE HWY | ||||||||
| Address2: | |||||||||
| City: | BEAVERTON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970053307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036269494 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2018 | ||||||||
| LastUpdateDate: | 08/15/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | C4156 | OR | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.