Provider Demographics
NPI:1851865133
Name:DALTON, ERIC TRAVIS (MA)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:TRAVIS
Last Name:DALTON
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 E SPRING ST
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-5066
Mailing Address - Country:US
Mailing Address - Phone:931-303-0665
Mailing Address - Fax:
Practice Address - Street 1:606 E SPRING ST
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-5066
Practice Address - Country:US
Practice Address - Phone:931-303-0665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-19
Last Update Date:2019-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health