Provider Demographics
NPI:1073824272
Name:JUREK, DANIEL JOHN (MMIN, MA)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:JOHN
Last Name:JUREK
Suffix:
Gender:M
Credentials:MMIN, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 RIDGEWAY DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-3414
Mailing Address - Country:US
Mailing Address - Phone:337-993-1960
Mailing Address - Fax:337-993-1961
Practice Address - Street 1:143 RIDGEWAY DR
Practice Address - Street 2:SUITE 106
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-3414
Practice Address - Country:US
Practice Address - Phone:337-993-1960
Practice Address - Fax:337-993-1961
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2823101YP2500X
LAMFT757106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist