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Individual

EBEN BLAKE DANIELSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
815 37TH AVE S, MOORHEAD, MN 56560-5524
(701) 451-4811
(651) 925-0057
Mailing address
1201 25TH ST S, FARGO, ND 58103-2311
(701) 451-4855
(651) 925-0057

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
01905
MN
101YP2500X
Professional Counselor
Primary
CC01693
MN

Other

Enumeration date
11/07/2017
Last updated
02/25/2020
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