Provider Demographics
NPI:1962704890
Name:PADEN, DANIEL ALLEN (MA PSYD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:ALLEN
Last Name:PADEN
Suffix:
Gender:M
Credentials:MA PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 E PIONEER
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-3265
Mailing Address - Country:US
Mailing Address - Phone:253-697-8410
Mailing Address - Fax:253-697-3730
Practice Address - Street 1:325 E PIONEER
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3265
Practice Address - Country:US
Practice Address - Phone:253-697-8410
Practice Address - Fax:253-697-3730
Is Sole Proprietor?:No
Enumeration Date:2010-11-29
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE9283101Y00000X
WACG60458966101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE96097OtherBCBS
NE470798717-26, 27Medicaid