Provider Demographics
NPI:1730638040
Name:DALLMAN, MARY (LMFT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:DALLMAN
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 1:212 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-2512
Mailing Address - Country:US
Mailing Address - Phone:360-870-5120
Mailing Address - Fax:360-533-2718
Practice Address - Street 1:203 4TH AVE E STE 411
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-1189
Practice Address - Country:US
Practice Address - Phone:360-870-5120
Practice Address - Fax:360-533-2718
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-27
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF0002416106H00000X
WALF00002416106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2075234Medicaid