Provider Demographics
NPI:1285420950
Name:KILLIAN, DUSTIN EUGENE
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:EUGENE
Last Name:KILLIAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 N PARKWAY DR # 125
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93728-2724
Mailing Address - Country:US
Mailing Address - Phone:559-246-0322
Mailing Address - Fax:
Practice Address - Street 1:933 N PARKWAY DR # 125
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93728-2724
Practice Address - Country:US
Practice Address - Phone:559-246-0322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-17
Last Update Date:2025-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)