| Stacy Reuille-dupont, Llc | |
|
1305 Escalante Dr # 203 Durango CO 81303-8931 | |
| (970) 749-8227 | |
| Not Available |
| Full Name | Stacy Reuille-dupont, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1305 Escalante Dr # 203, Durango, Colorado |
| Authorized Official Name and Position | Jessica Stockton (OFFICE MANAGER) |
| Authorized Official Contact | 9704221761 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Stacy Reuille-dupont, Llc 1305 Escalante Dr # 203 Durango CO 81303-8931 Ph: (970) 749-8227 | Stacy Reuille-dupont, Llc 1305 Escalante Dr # 203 Durango CO 81303-8931 Ph: (970) 749-8227 |
| NPI Number | 1740777507 |
|---|---|
| Provider Enumeration Date | 04/17/2018 |
| Last Update Date | 07/23/2024 |
| Certification Date | 07/23/2024 |
| Medicare PECOS PAC ID | 9234485517 |
|---|---|
| Medicare Enrollment ID | O20180628000837 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740777507 | NPI | - | NPPES |
| 49670379 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | 4577 (Colorado) | Primary |
| Provider Name | Stacy A Reuille- Dupont |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1851628713 PECOS PAC ID: 8224313325 Enrollment ID: I20170331000513 |
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