Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | 16689 |
NPI | 1174067748 |
---|---|
Provider Name | Mr. Derek Daniel |
First Address | Indianapolis, IN 46237-3825 |
Second Address | Indianapolis, IN 46237-3825 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2016 |
Last Update Date | 22/10/2019 |