Provider Demographics
NPI:1477630119
Name:DOCHTERMAN, BEVERLY KAYE (MA LMFT)
Entity Type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:KAYE
Last Name:DOCHTERMAN
Suffix:
Gender:F
Credentials:MA LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:984 S GLENDORA AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740
Mailing Address - Country:US
Mailing Address - Phone:626-359-6226
Mailing Address - Fax:626-359-6226
Practice Address - Street 1:503 1/2 S MYRTLE
Practice Address - Street 2:#4
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016
Practice Address - Country:US
Practice Address - Phone:909-621-9023
Practice Address - Fax:909-482-2211
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC34007106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist