Healthcare Provider Details

I. General information

NPI: 1710054812
Provider Name (Legal Business Name): DOROTHY A CLEARY MFTI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DORY CLEARY MFTI

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

592 RIO LINDO AVENUE
CHICO CA
95926
US

IV. Provider business mailing address

PO BOX 6372
CHICO CA
95926
US

V. Phone/Fax

Practice location:
  • Phone: 530-891-2775
  • Fax: 530-895-6547
Mailing address:
  • Phone: 530-345-4403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF48821
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: