Basic Information
| Provider Information | |||||||||
| NPI: | 1639817091 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DOTY | ||||||||
| FirstName: | KATIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 625 E MAIN ST APT A | ||||||||
| Address2: | |||||||||
| City: | COTTAGE GROVE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974242071 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5416805116 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1255 PEARL ST | ||||||||
| Address2: | |||||||||
| City: | EUGENE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974013570 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5416876983 | ||||||||
| FaxNumber: | 5416847638 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2022 | ||||||||
| LastUpdateDate: | 05/25/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.