Provider Demographics
NPI:1962991232
Name:MUTCHELKNAUS, DANAE LYNN
Entity type:Individual
Prefix:
First Name:DANAE
Middle Name:LYNN
Last Name:MUTCHELKNAUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DANAE
Other - Middle Name:LYNN
Other - Last Name:VANROEKEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, NCC, LAC, LPC
Mailing Address - Street 1:440 N WOLFE RD
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94085-3869
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:57107
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57107
Practice Address - Country:US
Practice Address - Phone:605-605-6056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-02
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD17031751101YA0400X
SDLPC20338101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)