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NPI Code Detail

MEDICARE: DR. MAHLON BENTLEY DALLEY PH.D.

MEDICARE: DR. MAHLON BENTLEY DALLEY PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologistPY 00002302WA

General Provider Information

NPI Number : 1437452166
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MAHLON BENTLEY DALLEY PH.D.
Provider Business Mailing Address
First Line : 928 N HOMESTEAD DR
Second Line :
City : LIBERTY LAKE
State : WA
Zip : 99019-8566
Country : US
Telephone Number : 509-892-0896
Fax Number :
Provider Business Practice Location Address
First Line : 1330 N WASHINGTON ST STE 4200
Second Line :
City : SPOKANE
State : WA
Zip : 99201-2476
Country : US
Telephone Number : 509-325-8182
Fax Number : 509-327-7726
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/20/2010
Last Update Date : 12/20/2010

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Directions to “ DR. MAHLON BENTLEY DALLEY PH.D.” Practice Location

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