Provider Demographics
NPI:1538598016
Name:MARSH, DANIEL LESLIE (LCPC)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:LESLIE
Last Name:MARSH
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 S PARK AVE
Mailing Address - Street 2:
Mailing Address - City:HERRIN
Mailing Address - State:IL
Mailing Address - Zip Code:62948-4177
Mailing Address - Country:US
Mailing Address - Phone:618-988-1757
Mailing Address - Fax:618-988-1700
Practice Address - Street 1:1220 S PARK AVE
Practice Address - Street 2:
Practice Address - City:HERRIN
Practice Address - State:IL
Practice Address - Zip Code:62948-4177
Practice Address - Country:US
Practice Address - Phone:618-988-1757
Practice Address - Fax:618-988-1700
Is Sole Proprietor?:No
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180005118101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health