Provider Demographics
NPI:1306415187
Name:HILES, DUSTIN RYDER (LPC)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:RYDER
Last Name:HILES
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:DUSTIN
Other - Middle Name:
Other - Last Name:HILES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:1905 15TH ST UNIT 2091
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80306-8483
Mailing Address - Country:US
Mailing Address - Phone:970-614-8765
Mailing Address - Fax:
Practice Address - Street 1:100 ARAPAHOE AVE STE 9
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5854
Practice Address - Country:US
Practice Address - Phone:970-614-8765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-24
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0017257101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional