Provider Demographics
NPI:1972380988
Name:RYLATT, DILLON SAMUEL (LISAC)
Entity Type:Individual
Prefix:
First Name:DILLON
Middle Name:SAMUEL
Last Name:RYLATT
Suffix:
Gender:M
Credentials:LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 N. CENTRAL AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2929
Mailing Address - Country:US
Mailing Address - Phone:602-302-7715
Mailing Address - Fax:602-302-7925
Practice Address - Street 1:3864 N. 27TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85017-4703
Practice Address - Country:US
Practice Address - Phone:602-685-6000
Practice Address - Fax:602-302-7925
Is Sole Proprietor?:No
Enumeration Date:2023-09-12
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ155299101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)