Provider Demographics
NPI:1770898975
Name:DESTLER, DUSTIN (MS)
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:
Last Name:DESTLER
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 HAILI ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2500
Mailing Address - Country:US
Mailing Address - Phone:818-515-4483
Mailing Address - Fax:
Practice Address - Street 1:313 HAILI ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2500
Practice Address - Country:US
Practice Address - Phone:818-515-4483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-11
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health