Provider Demographics
NPI:1154700664
Name:DAILY, SAMUEL (LPC, CCTP)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:DAILY
Suffix:
Gender:M
Credentials:LPC, CCTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 W SUNBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703
Mailing Address - Country:US
Mailing Address - Phone:479-301-2284
Mailing Address - Fax:479-301-2338
Practice Address - Street 1:28 W SUNBRIDGE DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703
Practice Address - Country:US
Practice Address - Phone:479-301-2284
Practice Address - Fax:479-301-2338
Is Sole Proprietor?:No
Enumeration Date:2015-05-29
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1209086101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional