Provider Demographics
NPI:1780410407
Name:DREW, DILLON JAMES
Entity type:Individual
Prefix:
First Name:DILLON
Middle Name:JAMES
Last Name:DREW
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 1:1005 W DAVIS ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTE
Mailing Address - State:MO
Mailing Address - Zip Code:65248-1063
Mailing Address - Country:US
Mailing Address - Phone:660-414-6987
Mailing Address - Fax:
Practice Address - Street 1:224 N WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:MOBERLY
Practice Address - State:MO
Practice Address - Zip Code:65270-1534
Practice Address - Country:US
Practice Address - Phone:660-236-2818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor