Provider Demographics
NPI:1639454812
Name:DALLEY, ABRAM CLINT (LPC)
Entity Type:Individual
Prefix:
First Name:ABRAM
Middle Name:CLINT
Last Name:DALLEY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1664 S DIXIE DR STE E102
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-7329
Mailing Address - Country:US
Mailing Address - Phone:435-703-9647
Mailing Address - Fax:435-703-6003
Practice Address - Street 1:1664 S DIXIE DR STE E102
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-7329
Practice Address - Country:US
Practice Address - Phone:435-703-9647
Practice Address - Fax:435-703-6003
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-19
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
294292-6004101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health