Provider Demographics
NPI:1134264617
Name:DANIELS, DAVID L (LMFT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:DANIELS
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4245 KEMP BLVD STE 720
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-2833
Mailing Address - Country:US
Mailing Address - Phone:940-247-0766
Mailing Address - Fax:
Practice Address - Street 1:4245 KEMP BLVD STE 720
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-2833
Practice Address - Country:US
Practice Address - Phone:940-247-0766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4954106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX170245801Medicaid
TX8594BHOtherBLUE CROSS ID NUMBER
751850370OtherTAX ID NUMBER