Provider Demographics
NPI:1114595113
Name:HARUYAMA, DOROTHY (PHD)
Entity Type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:
Last Name:HARUYAMA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 S HOWES ST FL 1
Mailing Address - Street 2:P.O. BOX 655
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80521-2795
Mailing Address - Country:US
Mailing Address - Phone:970-213-1899
Mailing Address - Fax:
Practice Address - Street 1:301 S HOWES ST FL 1
Practice Address - Street 2:P.O. BOX 655
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80521-2795
Practice Address - Country:US
Practice Address - Phone:970-213-1899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-15
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0006323103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling