Provider Demographics
NPI:1821615089
Name:JEFFRIES, DILLON
Entity Type:Individual
Prefix:
First Name:DILLON
Middle Name:
Last Name:JEFFRIES
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 1:2295 S JASPER WAY APT B
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80013-6346
Mailing Address - Country:US
Mailing Address - Phone:720-322-4350
Mailing Address - Fax:
Practice Address - Street 1:2295 S JASPER WAY APT B
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80013-6346
Practice Address - Country:US
Practice Address - Phone:720-322-4350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-02
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician