Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | LPC-1937 | AZ |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | LISAC-1446 | AZ |
NPI | 1083967079 |
---|---|
Provider Name | Dr. Michael David Mcdaniel |
First Address | Scottsdale, AZ 85256-4019 |
Second Address | Scottsdale, AZ 85256-4019 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2012 |
Last Update Date | 16/10/2012 |