Individual
DYLAN THOMAS EILKEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1230 N MARENGO AVE, PASADENA, CA 91103-2217
(626) 797-1124
Mailing address
1230 N MARENGO AVE, PASADENA, CA 91103-2217
(626) 797-1124
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
R1523050823
CA
175T00000X
Peer Specialist
Primary
MPSS-GKTBSF
CA
Other
Enumeration date
08/31/2023
Last updated
10/16/2024
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