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General NPI Number Information
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NPI Number | 1477802320
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Entity Type | Individual
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Provider Name | DILLON SMALL PSYD
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Gender | Male
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Dates
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Enumeration Date | 09/06/2012
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Last Update Date | 03/24/2022
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Provider Practice Location Address
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Address Line | 2348 SIJAN DR STE 2A13
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City | USAF ACADEMY
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State | CO
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Zip | 80840-8203
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Country | US
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Telephone | 317-362-4878
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Fax |
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Provider Business Mailing Address
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Address Line | 4760 SOUTH SEPULVEDA BLVD
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City | CULVER CITY
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State | CA
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Zip | 90230
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Country | US
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Telephone | 310-390-6612
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 20043068A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY..0005552
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY.0005552
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License Number State | CO
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