Provider Demographics
NPI:1376899591
Name:DALEY, TERRY M (LICDC)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:M
Last Name:DALEY
Suffix:
Gender:M
Credentials:LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3135 EUCLID AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44115-2524
Mailing Address - Country:US
Mailing Address - Phone:216-391-2030
Mailing Address - Fax:216-431-7189
Practice Address - Street 1:3135 EUCLID AVE STE 202
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-2524
Practice Address - Country:US
Practice Address - Phone:216-391-2030
Practice Address - Fax:216-431-7189
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-25
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH954290101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)