Provider Demographics
NPI:1205439692
Name:ORR, DYLAN JESTIN
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:JESTIN
Last Name:ORR
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 1:2330 NICHOLS ST
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-3458
Mailing Address - Country:US
Mailing Address - Phone:907-279-6617
Mailing Address - Fax:907-274-0636
Practice Address - Street 1:2330 NICHOLS ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-3458
Practice Address - Country:US
Practice Address - Phone:907-279-6617
Practice Address - Fax:907-274-0636
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health