Provider Demographics
NPI:1235688565
Name:DALES, ALICE
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:DALES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:828 HIGHWAY 457
Mailing Address - Street 2:
Mailing Address - City:LECOMPTE
Mailing Address - State:LA
Mailing Address - Zip Code:71346-8782
Mailing Address - Country:US
Mailing Address - Phone:318-613-7671
Mailing Address - Fax:
Practice Address - Street 1:828 HIGHWAY 457
Practice Address - Street 2:
Practice Address - City:LECOMPTE
Practice Address - State:LA
Practice Address - Zip Code:71346-8782
Practice Address - Country:US
Practice Address - Phone:318-613-7671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-28
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst