Provider Demographics
NPI:1588012777
Name:DOERKSEN, DANA (PHD)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:DOERKSEN
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 1:5900 SOUTHWEST PKWY STE 5-520
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735-6207
Mailing Address - Country:US
Mailing Address - Phone:512-810-9882
Mailing Address - Fax:
Practice Address - Street 1:5900 SOUTHWEST PKWY STE 5-520
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-6207
Practice Address - Country:US
Practice Address - Phone:512-810-9882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-27
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR000707101YA0400X
TX65489101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional