Healthcare Provider Details

I. General information

NPI: 1871194266
Provider Name (Legal Business Name): DILLON RAYMOND GILES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2020
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

296 STAFFORD LN
DELTA CO
81416-2273
US

IV. Provider business mailing address

PO BOX 10100
DELTA CO
81416-0008
US

V. Phone/Fax

Practice location:
  • Phone: 970-874-5777
  • Fax:
Mailing address:
  • Phone: 970-874-2470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0019187
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0019187
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: