Provider Demographics
NPI:1285811042
Name:OTIS, DEBORAH ANN (MA, CDCI)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:ANN
Last Name:OTIS
Suffix:
Gender:F
Credentials:MA, CDCI
Other - Prefix:MS
Other - First Name:DEBS
Other - Middle Name:ANN
Other - Last Name:OTIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, CDCI
Mailing Address - Street 1:3100 S CUSHMAN ST
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-7516
Mailing Address - Country:US
Mailing Address - Phone:907-452-6251
Mailing Address - Fax:907-456-7371
Practice Address - Street 1:3100 S CUSHMAN ST
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-7516
Practice Address - Country:US
Practice Address - Phone:907-452-6251
Practice Address - Fax:907-456-7371
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health