Provider Demographics
NPI:1396998316
Name:MCDORMAN, D. WES
Entity type:Individual
Prefix:MR
First Name:D.
Middle Name:WES
Last Name:MCDORMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9255 LOY LANE
Mailing Address - Street 2:B
Mailing Address - City:CORNVILLE
Mailing Address - State:AZ
Mailing Address - Zip Code:86325
Mailing Address - Country:US
Mailing Address - Phone:928-305-5125
Mailing Address - Fax:
Practice Address - Street 1:9255 LOY LANE
Practice Address - Street 2:B
Practice Address - City:CORNVILLE
Practice Address - State:AZ
Practice Address - Zip Code:86325
Practice Address - Country:US
Practice Address - Phone:928-305-5125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor