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General NPI Number Information
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NPI Number | 1255125704
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Entity Type | Individual
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Provider Name | CALEB DOTSON I LMHC (TEMPORARY)
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Gender | Male
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Dates
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Enumeration Date | 04/08/2025
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Last Update Date | 04/08/2025
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Provider Practice Location Address
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Address Line | 1660 OLD PECOS TRL STE A
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City | SANTA FE
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State | NM
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Zip | 87505-4779
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Country | US
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Telephone | 505-690-1697
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Fax |
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Provider Business Mailing Address
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Address Line | 1660 OLD PECOS TRL STE A
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City | SANTA FE
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State | NM
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Zip | 87505-4779
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Country | US
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Telephone | 505-690-1697
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | CTB-2025-0198
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License Number State | NM
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