Provider Demographics
NPI:1780120642
Name:DILLREE, STACEY (LMT, BCMT)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:DILLREE
Suffix:
Gender:F
Credentials:LMT, BCMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1911 GROVESPRING ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-1085
Mailing Address - Country:US
Mailing Address - Phone:702-379-3704
Mailing Address - Fax:
Practice Address - Street 1:2800 W SAHARA AVE STE 8B-C
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-4390
Practice Address - Country:US
Practice Address - Phone:702-379-3704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-16
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4884405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes405300000XOther Service ProvidersPrevention Professional