Provider Demographics
NPI:1639257843
Name:DALEY, PAUL CRAYTON (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:CRAYTON
Last Name:DALEY
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:PO BOX 1655
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-0033
Mailing Address - Country:US
Mailing Address - Phone:360-452-4345
Mailing Address - Fax:
Practice Address - Street 1:809 S CHASE ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-7803
Practice Address - Country:US
Practice Address - Phone:360-452-4345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA913103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7033509Medicaid