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General NPI Number Information
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NPI Number | 1740777507
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Entity Type | Organization
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Legal Business Name | STACY REUILLE-DUPONT, LLC
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Dates
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Enumeration Date | 04/17/2018
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Last Update Date | 07/23/2024
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Provider Practice Location Address
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Address Line | 1305 ESCALANTE DR # 203
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City | DURANGO
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State | CO
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Zip | 81303-8931
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Country | US
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Telephone | 970-749-8227
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Fax |
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Provider Business Mailing Address
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Address Line | 1305 ESCALANTE DR # 203
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City | DURANGO
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State | CO
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Zip | 81303-8931
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Country | US
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Telephone | 970-749-8227
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | JESSICA STOCKTON
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Credential | CCMA, BSHM
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Telephone | 970-422-1761
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 4577
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License Number State | CO
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