Provider Demographics
NPI:1598012965
Name:DOCKEN, JANE LYNN (LPC)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:LYNN
Last Name:DOCKEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:JANE
Other - Middle Name:LYNN
Other - Last Name:ADDIS-DOCKEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:877 NE CHURCH AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-1590
Mailing Address - Country:US
Mailing Address - Phone:541-817-2905
Mailing Address - Fax:
Practice Address - Street 1:877 NE CHURCH AVE
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-1590
Practice Address - Country:US
Practice Address - Phone:541-817-2905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-05
Last Update Date:2012-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC1327101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor