Provider Demographics
NPI:1780106138
Name:DOTY, JAMIE (LPCC)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:DOTY
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1162 LEXINGTON ROAD
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-9392
Mailing Address - Country:US
Mailing Address - Phone:502-863-6426
Mailing Address - Fax:
Practice Address - Street 1:1162 LEXINGTON RD
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324
Practice Address - Country:US
Practice Address - Phone:502-863-6426
Practice Address - Fax:502-868-9724
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-07
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
KY172707101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health