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General NPI Number Information
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NPI Number | 1134474083
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Entity Type | Individual
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Provider Name | WILLIAM T DALTON III PHD
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Gender | Male
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Dates
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Enumeration Date | 07/17/2012
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Last Update Date | 08/26/2021
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Provider Practice Location Address
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Address Line | 942 COMMONWEALTH BLVD
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City | TUPELO
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State | MS
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Zip | 38804-9762
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Country | US
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Telephone | 662-620-0101
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Fax | 662-620-0095
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Provider Business Mailing Address
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Address Line | PO BOX 151
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City | CORINTH
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State | MS
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Zip | 38835-0151
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Country | US
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Telephone | 423-747-6041
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | P2791
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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