Doctor Name: | MICHELLE DOUGLAS |
NPI Number: | 1962578765 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA, LPC |
License Number: | 19377 |
Business Practice Address: | 222 Coneflower Dr Spring Branch, TX - 780705039 |
Business Phone Number: | 8305158988 |
Business Fax Number: | 8304388051 |
Mailing Address: | 20475 State Hwy 46 W, Suite 180, Pmb618 SPRING BRANCH |
State: | TX |
Postal Code: | 780706124 |
Phone Number: | 8305158988 |
Fax Number: | 8304388051 |
NPI Enumeration Date: | 11/27/2006 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 19377 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |