Provider Demographics
NPI:1841331477
Name:IRIKS, DOROTHY LYNN (MFT)
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:LYNN
Last Name:IRIKS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:467 HUNTER LANE EXT
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-9716
Mailing Address - Country:US
Mailing Address - Phone:707-529-9465
Mailing Address - Fax:
Practice Address - Street 1:3440 AIRWAY DR STE E
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-2065
Practice Address - Country:US
Practice Address - Phone:707-544-3299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA82225106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health