Individual
MR. DANIEL RUSEBORN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMFT, LMHC, CSAC
Contact information
Practice address
1 JARRETT WHITE RD, TRIPLER ARMY MEDICAL CENTER, HI 96859-5001
(808) 433-1389
Mailing address
1 JARRETT WHITE RD, TRIPLER ARMY MEDICAL CENTER, HI 96859-5001
(808) 433-6098
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CSAC1715-12
HI
101YM0800X
Mental Health Counselor
LMHC363
HI
106H00000X
Marriage & Family Therapist
MFT-569
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
VAD000
UPIN
—
Enumeration date
11/21/2017
Last updated
09/14/2021
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