Provider Demographics
NPI:1770155822
Name:DALLY-CLEYS, DANA MARIE (LADC)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:MARIE
Last Name:DALLY-CLEYS
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:MARIE
Other - Last Name:DALLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LADC
Mailing Address - Street 1:15096 COUNTY ROAD 159
Mailing Address - Street 2:
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401-5673
Mailing Address - Country:US
Mailing Address - Phone:218-851-5125
Mailing Address - Fax:
Practice Address - Street 1:606 FRONT ST
Practice Address - Street 2:
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401-3602
Practice Address - Country:US
Practice Address - Phone:218-838-9471
Practice Address - Fax:218-316-3819
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN301217101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)