Provider Demographics
NPI:1528316031
Name:LIBSTORFF, DANIEL S (PCC-S)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:S
Last Name:LIBSTORFF
Suffix:
Gender:M
Credentials:PCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5670 EAGLE CREEK CT
Mailing Address - Street 2:
Mailing Address - City:MAINEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45039-7200
Mailing Address - Country:US
Mailing Address - Phone:513-288-8815
Mailing Address - Fax:
Practice Address - Street 1:7757 CENTRAL PARKE BVLD
Practice Address - Street 2:SUITE 225
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040
Practice Address - Country:US
Practice Address - Phone:513-288-8815
Practice Address - Fax:513-229-8963
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-15
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0004149101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional