Healthcare Provider Details

I. General information

NPI: 1649398868
Provider Name (Legal Business Name): DORTHY B KOTMANN M.ED., LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 S WASHINGTON AVE
BRYAN TX
77803-3985
US

IV. Provider business mailing address

1259 COUNTY ROAD 425
DIME BOX TX
77853
US

V. Phone/Fax

Practice location:
  • Phone: 979-779-2864
  • Fax: 979-779-8522
Mailing address:
  • Phone: 979-884-0417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11970
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: