Provider Demographics
NPI:1134672496
Name:EGGLESTON, DUSTIN JAMES (PLADC)
Entity type:Individual
Prefix:MR
First Name:DUSTIN
Middle Name:JAMES
Last Name:EGGLESTON
Suffix:
Gender:
Credentials:PLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 NIOBRARA AVE
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:NE
Mailing Address - Zip Code:69301-3017
Mailing Address - Country:US
Mailing Address - Phone:308-760-2679
Mailing Address - Fax:
Practice Address - Street 1:212 BOX BUTTE AVE
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:NE
Practice Address - Zip Code:69301-3742
Practice Address - Country:US
Practice Address - Phone:308-761-4226
Practice Address - Fax:308-635-9672
Is Sole Proprietor?:No
Enumeration Date:2016-08-03
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
NE2281101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE470519633Medicaid