Doctor Name: | LUCY MARILYN DOUGLAS |
NPI Number: | 1053434928 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMHC, ATR-BC |
License Number: | 00355 |
Business Practice Address: | 2311 Warren Ave Saint Charles, IA - 502408502 |
Business Phone Number: | 6413962703 |
Business Fax Number: | |
Mailing Address: | 2311 Warren Ave, SAINT CHARLES |
State: | IA |
Postal Code: | 502408502 |
Phone Number: | 6413962703 |
Fax Number: | |
NPI Enumeration Date: | 04/07/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 00355 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |