MEDICARE: BRYAN J DALLEY M.ED., ACMHC

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
1	101YM0800X	Mental Health Counselor	142232426009	UT

General Provider Information

NPI Number	:	1700779253
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYAN J DALLEY M.ED., ACMHC

Provider Business Mailing Address
First Line	:	426 W 200 N APT 102
Second Line	:
City	:	SPRINGVILLE
State	:	UT
Zip	:	84663-6044
Country	:	US
Telephone Number	:	801-635-5075
Fax Number	:

Provider Business Practice Location Address
First Line	:	3585 N UNIVERSITY AVE STE 300
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84604-6611
Country	:	US
Telephone Number	:	801-797-1111
Fax Number	:	801-996-0158

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2025
Last Update Date	:	06/02/2025

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