Provider Demographics
NPI:1215300066
Name:JILEK, DARREN (PHD)
Entity type:Individual
Prefix:DR
First Name:DARREN
Middle Name:
Last Name:JILEK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39218 PRAIRIE RD
Mailing Address - Street 2:
Mailing Address - City:MELLETTE
Mailing Address - State:SD
Mailing Address - Zip Code:57461-5206
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:39218 PRAIRIE RD
Practice Address - Street 2:
Practice Address - City:MELLETTE
Practice Address - State:SD
Practice Address - Zip Code:57461-5206
Practice Address - Country:US
Practice Address - Phone:605-228-4877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-02
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD536103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist