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1970 E 3rd Ave Ste 101 Durango CO 81301-5056 | |
| (970) 422-1761 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Psychologist |
| Location | 1970 E 3rd Ave Ste 101, Durango, Colorado |
| Authorized Official Name and Position | Stacy Reuille-dupont (MEDICAL OWNER) |
| Authorized Official Contact | 9704221761 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1970 E 3rd Ave Ste 101 Durango CO 81301-5056 Ph: (970) 422-1761 | 1970 E 3rd Ave Ste 101 Durango CO 81301-5056 Ph: (970) 422-1761 |
| NPI Number | 1487485843 |
|---|---|
| Provider Enumeration Date | 08/08/2024 |
| Last Update Date | 01/10/2025 |
| Certification Date | 01/10/2025 |
| Medicare PECOS PAC ID | 3971043464 |
|---|---|
| Medicare Enrollment ID | O20240911001735 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487485843 | NPI | - | NPPES |
| Provider Name | Stacy Reuille- Dupont |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1851628713 PECOS PAC ID: 8224313325 Enrollment ID: I20170331000513 |
| Provider Name | Megan Oberholtzer |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1942995063 PECOS PAC ID: 2860924891 Enrollment ID: I20241016000799 |
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