Healthcare Provider Details

I. General information

NPI: 1720596703
Provider Name (Legal Business Name): JANIS DOCHTERMAN MA, LPCC, RYT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2018
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5378 STERLING DRIVE STUDIO #3
BOULDER CO
80301
US

IV. Provider business mailing address

954 WINDOM PEAK DR
SUPERIOR CO
80027-6137
US

V. Phone/Fax

Practice location:
  • Phone: 303-884-6673
  • Fax:
Mailing address:
  • Phone: 319-471-0140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0014927
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: