Individual
MR. DEREK DALTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAC
Contact information
Practice address
1312 NORTH MERIDIAN, KALISPELL, MT 59904-0115
(406) 756-6453
(406) 756-8546
Mailing address
1312 NORTH MERIDIAN, KALISPELL, MT 59904
(406) 756-6453
(406) 756-8546
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
639
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000076391
BLUE CROSS BLUE SHIELD
MT
05
—
0320372
—
MT
01
—
76555
CHIP
MT
Enumeration date
03/08/2007
Last updated
07/08/2007
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