Doctor Name: | THERESA A DOUGLAS |
NPI Number: | 1376971226 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS., LPC-T |
License Number: | 1844-226 |
Business Practice Address: | 17 S. River St 254 Janesville, WI - 535483863 |
Business Phone Number: | 6087555260 |
Business Fax Number: | 6087555267 |
Mailing Address: | 17 S. River St., Suite 254 JANESVILLE |
State: | WI |
Postal Code: | 535483862 |
Phone Number: | 6087555260 |
Fax Number: | 6087555267 |
NPI Enumeration Date: | 10/30/2013 |
NPI Last Update Date: | 10/30/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | 1844-226 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |