Provider Demographics
NPI:1881201028
Name:NEIGHBORS, DALLAS RENAE (SUDPT)
Entity Type:Individual
Prefix:MISS
First Name:DALLAS
Middle Name:RENAE
Last Name:NEIGHBORS
Suffix:
Gender:F
Credentials:SUDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 YAKIMA AVE APT 305
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4453
Mailing Address - Country:US
Mailing Address - Phone:253-304-6549
Mailing Address - Fax:
Practice Address - Street 1:711 S 25TH ST STE B
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4306
Practice Address - Country:US
Practice Address - Phone:253-536-2881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG61103555101YM0800X
WACO61083714101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty