Basic Information
| Provider Information | |||||||||
| NPI: | 1326004367 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCDANIEL | ||||||||
| FirstName: | CHRISTIAN | ||||||||
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| Credential: | CSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 812 E JOLLY RD | ||||||||
| Address2: | STE 210 | ||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 489106818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173468410 | ||||||||
| FaxNumber: | 5173468291 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 E STURGIS ST | ||||||||
| Address2: | |||||||||
| City: | SAINT JOHNS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488792068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9892245300 | ||||||||
| FaxNumber: | 5173468291 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6801073040 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.