Provider Demographics
NPI:1720596703
Name:DOCHTERMAN, JANIS (MA, LPCC, RYT)
Entity Type:Individual
Prefix:
First Name:JANIS
Middle Name:
Last Name:DOCHTERMAN
Suffix:
Gender:F
Credentials:MA, LPCC, RYT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:954 WINDOM PEAK DR
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:CO
Mailing Address - Zip Code:80027-6137
Mailing Address - Country:US
Mailing Address - Phone:319-471-0140
Mailing Address - Fax:
Practice Address - Street 1:5378 STERLING DRIVE
Practice Address - Street 2:STUDIO #3
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301
Practice Address - Country:US
Practice Address - Phone:303-884-6673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0014927101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health