Provider Demographics
NPI:1649398868
Name:KOTMANN, DORTHY B (MED, LPC)
Entity Type:Individual
Prefix:MRS
First Name:DORTHY
Middle Name:B
Last Name:KOTMANN
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1259 COUNTY ROAD 425
Mailing Address - Street 2:
Mailing Address - City:DIME BOX
Mailing Address - State:TX
Mailing Address - Zip Code:77853
Mailing Address - Country:US
Mailing Address - Phone:979-884-0417
Mailing Address - Fax:
Practice Address - Street 1:702 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77803-3985
Practice Address - Country:US
Practice Address - Phone:979-779-2864
Practice Address - Fax:979-779-8522
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11970101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health