Doctor Name: | MR. BRETT TYLER DILLARD |
NPI Number: | 1003136672 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | B.S.W. |
License Number: | |
Business Practice Address: | 39 Lafayette St Pontotoc, MS - 388632837 |
Business Phone Number: | 6625096759 |
Business Fax Number: | 6625096761 |
Mailing Address: | 39 Lafayette St, PONTOTOC |
State: | MS |
Postal Code: | 388632837 |
Phone Number: | 6625099300 |
Fax Number: | 6625096698 |
NPI Enumeration Date: | 06/07/2010 |
NPI Last Update Date: | 06/07/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |