Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003136672 |
---|---|
Provider Name | Mr. Brett Tyler Dillard |
First Address | Pontotoc, MS 38863-2837 |
Second Address | Pontotoc, MS 38863-2837 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2010 |
Last Update Date | 07/06/2010 |