Provider Demographics
NPI:1477542785
Name:JENNETTE, DORJE MORGAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DORJE
Middle Name:MORGAN
Last Name:JENNETTE
Suffix:
Gender:M
Credentials:PSYD
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 72001
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95617-6001
Mailing Address - Country:US
Mailing Address - Phone:530-341-3103
Mailing Address - Fax:
Practice Address - Street 1:424 3RD ST # 72001
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-4519
Practice Address - Country:US
Practice Address - Phone:530-341-3103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-19
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22014103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist