Basic Information
| Provider Information | |||||||||
| NPI: | 1467822312 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DOTY | ||||||||
| FirstName: | SARA | ||||||||
| MiddleName: | RENE | ||||||||
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| Credential: | MA, LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14048 BELSAY RD | ||||||||
| Address2: | |||||||||
| City: | MILLINGTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 487469215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8103942186 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8341 OFFICE PARK DR STE E | ||||||||
| Address2: | |||||||||
| City: | GRAND BLANC | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48439 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8006931916 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2015 | ||||||||
| LastUpdateDate: | 02/27/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 106H00000X | 4101006816 | MI | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.