Provider Demographics
NPI:1649166992
Name:STAUB, DORIS KAY (INTERN)
Entity type:Individual
Prefix:
First Name:DORIS
Middle Name:KAY
Last Name:STAUB
Suffix:
Gender:F
Credentials:INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 374
Mailing Address - Street 2:
Mailing Address - City:TULELAKE
Mailing Address - State:CA
Mailing Address - Zip Code:96134-0374
Mailing Address - Country:US
Mailing Address - Phone:541-281-2151
Mailing Address - Fax:
Practice Address - Street 1:422 MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-6048
Practice Address - Country:US
Practice Address - Phone:541-851-3300
Practice Address - Fax:541-363-5675
Is Sole Proprietor?:No
Enumeration Date:2025-06-14
Last Update Date:2025-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health