Healthcare Provider Details

I. General information

NPI: 1255125704
Provider Name (Legal Business Name): CALEB DOTSON I LMHC (TEMPORARY)
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2025
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 OLD PECOS TRL STE A
SANTA FE NM
87505-4779
US

IV. Provider business mailing address

1660 OLD PECOS TRL STE A
SANTA FE NM
87505-4779
US

V. Phone/Fax

Practice location:
  • Phone: 505-690-1697
  • Fax:
Mailing address:
  • Phone: 505-690-1697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB-2025-0198
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: