Provider Demographics
NPI:1285720862
Name:DANIEL, DAVID CLIFFORD JR (PHD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CLIFFORD
Last Name:DANIEL
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:217 WOODWIND LANE
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-7754
Mailing Address - Country:US
Mailing Address - Phone:318-442-8905
Mailing Address - Fax:
Practice Address - Street 1:2495 SHREVEPORT HWY 71N
Practice Address - Street 2:116B PSYCHOLOGY CLINIC
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71306-9004
Practice Address - Country:US
Practice Address - Phone:318-473-0010
Practice Address - Fax:318-483-5096
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR84-02P103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical