Provider Demographics
NPI:1447387345
Name:OTTEN, ROBERT DREW (LAADC, M-RAS, CSC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:DREW
Last Name:OTTEN
Suffix:
Gender:M
Credentials:LAADC, M-RAS, CSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1241
Mailing Address - Street 2:
Mailing Address - City:MORRO BAY
Mailing Address - State:CA
Mailing Address - Zip Code:93443-1241
Mailing Address - Country:US
Mailing Address - Phone:805-428-0288
Mailing Address - Fax:
Practice Address - Street 1:2180 JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-4513
Practice Address - Country:US
Practice Address - Phone:805-781-4861
Practice Address - Fax:805-781-1227
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAO0509301519101YA0400X
CALCI0101214101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)