Provider Demographics
NPI:1922634492
Name:DOEGEY, JARED A
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:A
Last Name:DOEGEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1683 CIRRUS WAY
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-3232
Mailing Address - Country:US
Mailing Address - Phone:409-888-1411
Mailing Address - Fax:
Practice Address - Street 1:1683 CIRRUS WAY
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-3232
Practice Address - Country:US
Practice Address - Phone:409-888-1411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-17
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31677103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical