Provider Demographics
NPI:1003136672
Name:DILLARD, BRETT TYLER (BSW)
Entity Type:Individual
Prefix:MR
First Name:BRETT
Middle Name:TYLER
Last Name:DILLARD
Suffix:
Gender:M
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:PONTOTOC
Mailing Address - State:MS
Mailing Address - Zip Code:38863-2837
Mailing Address - Country:US
Mailing Address - Phone:662-509-9300
Mailing Address - Fax:662-509-6698
Practice Address - Street 1:39 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:PONTOTOC
Practice Address - State:MS
Practice Address - Zip Code:38863-2837
Practice Address - Country:US
Practice Address - Phone:662-509-6759
Practice Address - Fax:662-509-6761
Is Sole Proprietor?:No
Enumeration Date:2010-06-07
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health