Provider Demographics
NPI:1487485843
Name:STACY REUILLE-DUPONT
Entity type:Organization
Organization Name:STACY REUILLE-DUPONT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:REUILLE-DUPONT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:970-422-1761
Mailing Address - Street 1:1970 E 3RD AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-5056
Mailing Address - Country:US
Mailing Address - Phone:970-422-1761
Mailing Address - Fax:
Practice Address - Street 1:1970 E 3RD AVE STE 101
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5056
Practice Address - Country:US
Practice Address - Phone:970-422-1761
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-08
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty