Provider Demographics
NPI:1669943379
Name:DOYLE, TORY MICHELLE (SUDCC II-CS)
Entity type:Individual
Prefix:
First Name:TORY
Middle Name:MICHELLE
Last Name:DOYLE
Suffix:
Gender:F
Credentials:SUDCC II-CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 LAKEVIEW RD
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455-2623
Mailing Address - Country:US
Mailing Address - Phone:805-363-0040
Mailing Address - Fax:
Practice Address - Street 1:403 W MORRISON AVE
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93458-8166
Practice Address - Country:US
Practice Address - Phone:805-332-3647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-07
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10766101YA0400X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA420010DNOtherCEN-CAL