Healthcare Provider Details

I. General information

NPI: 1285420950
Provider Name (Legal Business Name): DUSTIN EUGENE KILLIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2025
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 E ST
FRESNO CA
93706-2024
US

IV. Provider business mailing address

933 N PARKWAY DR # 125
FRESNO CA
93728-2724
US

V. Phone/Fax

Practice location:
  • Phone: 559-268-6261
  • Fax:
Mailing address:
  • Phone: 559-246-0322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number21419
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: