Provider Demographics
NPI:1629647052
Name:DOTY, KELLY MARIE (MA)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:MARIE
Last Name:DOTY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:289 RIO LINDO AVE
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-1973
Mailing Address - Country:US
Mailing Address - Phone:530-519-5211
Mailing Address - Fax:
Practice Address - Street 1:1089 TRACY LN
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1449
Practice Address - Country:US
Practice Address - Phone:530-519-5211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-21
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health