Provider Demographics
NPI:1083622476
Name:ANTHON, DANNIEL JAMES (MA, ATR-BC, LCPC)
Entity type:Individual
Prefix:MR
First Name:DANNIEL
Middle Name:JAMES
Last Name:ANTHON
Suffix:
Gender:M
Credentials:MA, ATR-BC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1042 WESLEY AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-1161
Mailing Address - Country:US
Mailing Address - Phone:847-491-1095
Mailing Address - Fax:
Practice Address - Street 1:1042 WESLEY AVE
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-1161
Practice Address - Country:US
Practice Address - Phone:847-491-1095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL91192OtherART TX CREDENTIALS BD.
IL9678OtherAM. ART TX ASSOCIATION