Provider Demographics
NPI:1528095346
Name:DAILEY LIFE, INC.
Entity type:Organization
Organization Name:DAILEY LIFE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:810-720-5400
Mailing Address - Street 1:5038 MILLER RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-1071
Mailing Address - Country:US
Mailing Address - Phone:810-720-5400
Mailing Address - Fax:
Practice Address - Street 1:5038 MILLER RD
Practice Address - Street 2:SUITE B
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-1071
Practice Address - Country:US
Practice Address - Phone:810-720-5400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4101006010106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM0784Medicare ID - Type UnspecifiedGROUP SOCIAL WORKER #
MION2007Medicare ID - Type UnspecifiedGROUP MD #
MIOB56345Medicare ID - Type UnspecifiedGROUP PSYCHOLOGIST#