Provider Demographics
NPI:1447377395
Name:OTTEN, DEBORAH LYNNE (MFT)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:LYNNE
Last Name:OTTEN
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 1:4401 LAURELWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95864-0823
Mailing Address - Country:US
Mailing Address - Phone:916-359-7678
Mailing Address - Fax:
Practice Address - Street 1:2224 J ST
Practice Address - Street 2:SUITE 210
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-4712
Practice Address - Country:US
Practice Address - Phone:916-443-6253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA023109106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist