Provider Demographics
NPI:1750781712
Name:DOTEN, ROY
Entity type:Individual
Prefix:
First Name:ROY
Middle Name:
Last Name:DOTEN
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 1:55475 SANTA FE TRL
Mailing Address - Street 2:STE 100
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-3117
Mailing Address - Country:US
Mailing Address - Phone:855-365-6558
Mailing Address - Fax:
Practice Address - Street 1:55475 SANTA FE TRL
Practice Address - Street 2:STE 100
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-3117
Practice Address - Country:US
Practice Address - Phone:855-365-6558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA850012101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health