Provider Demographics
NPI:1063996072
Name:DANIEL DIRK
Entity type:Organization
Organization Name:DANIEL DIRK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPTERTOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DIRK
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:541-450-0493
Mailing Address - Street 1:320 SW L ST
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-2928
Mailing Address - Country:US
Mailing Address - Phone:541-450-0493
Mailing Address - Fax:
Practice Address - Street 1:777 NE 7TH ST STE 107
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-1632
Practice Address - Country:US
Practice Address - Phone:541-450-0493
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-17
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty