Provider Demographics
NPI:1295462919
Name:DINELEY, MICHAEL JAMES JR
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JAMES
Last Name:DINELEY
Suffix:JR
Gender:M
Credentials:
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 833
Mailing Address - Street 2:
Mailing Address - City:PANACA
Mailing Address - State:NV
Mailing Address - Zip Code:89042-0833
Mailing Address - Country:US
Mailing Address - Phone:559-429-9880
Mailing Address - Fax:
Practice Address - Street 1:500 YOUTH CENTER DR.
Practice Address - Street 2:
Practice Address - City:CALIENTE
Practice Address - State:NV
Practice Address - Zip Code:89008
Practice Address - Country:US
Practice Address - Phone:775-726-8244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV0306683655Medicaid