Provider Demographics
NPI:1205303336
Name:DALY, FLEET (CP60890141)
Entity type:Individual
Prefix:
First Name:FLEET
Middle Name:
Last Name:DALY
Suffix:
Gender:M
Credentials:CP60890141
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 E COZZA DR
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-6514
Mailing Address - Country:US
Mailing Address - Phone:509-325-6800
Mailing Address - Fax:509-321-0706
Practice Address - Street 1:1321 N ASH ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2803
Practice Address - Country:US
Practice Address - Phone:509-327-3120
Practice Address - Fax:509-327-3228
Is Sole Proprietor?:No
Enumeration Date:2018-10-26
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60890141101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)