Provider Demographics
NPI:1437452166
Name:DALLEY, MAHLON BENTLEY (PHD)
Entity Type:Individual
Prefix:DR
First Name:MAHLON
Middle Name:BENTLEY
Last Name:DALLEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:928 N HOMESTEAD DR
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-8566
Mailing Address - Country:US
Mailing Address - Phone:509-892-0896
Mailing Address - Fax:
Practice Address - Street 1:1330 N WASHINGTON ST STE 4200
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2476
Practice Address - Country:US
Practice Address - Phone:509-325-8182
Practice Address - Fax:509-327-7726
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-20
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY 00002302103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist