Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 30792 | TX |
N | 103T00000X | Psychologist | 30792 | TX |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 30792 | TX |
N | 103TC1900X | Counseling Psychologist | 30792 | TX |
N | 103TH0100X | Health Service | 30792 | TX |
NPI | 1104849751 |
---|---|
Provider Name | Dr. Stacia Marie Daniel |
First Address | San Antonio, TX 78258-4838 |
Second Address | San Antonio, TX 78258-4838 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1794141 | (05) | TX |