Provider Demographics
NPI:1992449821
Name:LAURICELLA, DANIELLE (PHD, LMFT)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:LAURICELLA
Suffix:
Gender:F
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1393 CAMBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-4208
Mailing Address - Country:US
Mailing Address - Phone:208-701-2065
Mailing Address - Fax:
Practice Address - Street 1:1393 CAMBRIDGE DR
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-4208
Practice Address - Country:US
Practice Address - Phone:208-701-2065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-26
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMFT-9441106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist