Provider Demographics
NPI:1770614380
Name:DALTON, MARI MICHELLE (MA, MFT)
Entity type:Individual
Prefix:MS
First Name:MARI
Middle Name:MICHELLE
Last Name:DALTON
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:DALTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, MFT
Mailing Address - Street 1:523 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-6407
Mailing Address - Country:US
Mailing Address - Phone:360-738-9880
Mailing Address - Fax:360-756-8519
Practice Address - Street 1:12 BELLWETHER WAY STE 220
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-2914
Practice Address - Country:US
Practice Address - Phone:360-738-9880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00001803106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist