Provider Demographics
NPI:1194085019
Name:MCDANIEL, BUNNOI A (LPC)
Entity type:Individual
Prefix:MS
First Name:BUNNOI
Middle Name:A
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1222 N MAIN AVE
Mailing Address - Street 2:SUITE 740
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-5712
Mailing Address - Country:US
Mailing Address - Phone:210-271-7411
Mailing Address - Fax:210-271-9414
Practice Address - Street 1:2321 S BELT LINE RD
Practice Address - Street 2:SUITE 120
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-4181
Practice Address - Country:US
Practice Address - Phone:927-646-0490
Practice Address - Fax:210-271-9414
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65649101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor