MEDICARE: KATIE DOTY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1639817091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE DOTY

Provider Business Mailing Address
First Line	:	625 E MAIN ST APT A
Second Line	:
City	:	COTTAGE GROVE
State	:	OR
Zip	:	97424-2071
Country	:	US
Telephone Number	:	541-680-5116
Fax Number	:

Provider Business Practice Location Address
First Line	:	1255 PEARL ST
Second Line	:
City	:	EUGENE
State	:	OR
Zip	:	97401-3570
Country	:	US
Telephone Number	:	541-687-6983
Fax Number	:	541-684-7638

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2022
Last Update Date	:	05/25/2022

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Directions to “ KATIE DOTY ” Practice Location

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