Provider Demographics
NPI:1871194266
Name:GILES, DILLON RAYMOND
Entity type:Individual
Prefix:
First Name:DILLON
Middle Name:RAYMOND
Last Name:GILES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 E ORCHARD STREET
Mailing Address - Street 2:
Mailing Address - City:HOTCHKISS
Mailing Address - State:CO
Mailing Address - Zip Code:81419-2815
Mailing Address - Country:US
Mailing Address - Phone:970-209-9634
Mailing Address - Fax:
Practice Address - Street 1:70 STAFFORD LN UNIT A
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:CO
Practice Address - Zip Code:81416-2260
Practice Address - Country:US
Practice Address - Phone:970-874-5777
Practice Address - Fax:970-546-4030
Is Sole Proprietor?:No
Enumeration Date:2020-11-03
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0019187101YM0800X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health