Provider Demographics
NPI:1578998209
Name:DALTON, MARTHA L (LMFT)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:L
Last Name:DALTON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5736 24TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55417-2708
Mailing Address - Country:US
Mailing Address - Phone:612-876-0898
Mailing Address - Fax:
Practice Address - Street 1:8085 WAYZATA BLVD STE 215
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55426-1457
Practice Address - Country:US
Practice Address - Phone:612-876-0898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-12
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3591106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist