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General NPI Number Information
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NPI Number | 1346901840
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Entity Type | Individual
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Provider Name | JOEL MICHAEL DORMER LMFT
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Gender | Male
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Dates
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Enumeration Date | 01/06/2022
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Last Update Date | 02/03/2025
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Provider Practice Location Address
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Address Line | 1400 OREGON ST
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City | REDDING
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State | CA
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Zip | 96001-1620
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Country | US
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Telephone | 530-232-0525
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Fax |
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Provider Business Mailing Address
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Address Line | 2157 SONOMA ST
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City | REDDING
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State | CA
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Zip | 96001-3008
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Country | US
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Telephone | 530-351-4151
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 152477
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License Number State | CA
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