Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | C1301 | OR |
N | 103TS0200X | School Psychologist | ID |
NPI | 1003966136 |
---|---|
Provider Name | Mr. Gary M. Daily |
First Address | Weiser, ID 83672-1721 |
Second Address | Ontario, OR 97914-2921 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2007 |
Last Update Date | 02/10/2007 |