Provider Demographics
NPI:1861524753
Name:MOFFETT, DANIELLE JEAN (MA)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:JEAN
Last Name:MOFFETT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2954 INDIAN CREEK DR
Mailing Address - Street 2:
Mailing Address - City:BISHOP
Mailing Address - State:CA
Mailing Address - Zip Code:93514-2912
Mailing Address - Country:US
Mailing Address - Phone:760-924-1757
Mailing Address - Fax:760-924-1741
Practice Address - Street 1:452 OLD MAMMOTH ROAD
Practice Address - Street 2:
Practice Address - City:MAMMOTH LAKES
Practice Address - State:CA
Practice Address - Zip Code:93546
Practice Address - Country:US
Practice Address - Phone:760-924-1757
Practice Address - Fax:760-924-1741
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health