Provider Demographics
NPI:1073859179
Name:DOUTHIT, MAURY JR
Entity Type:Individual
Prefix:MR
First Name:MAURY
Middle Name:
Last Name:DOUTHIT
Suffix:JR
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 1:16401 SE 24TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98008-5432
Mailing Address - Country:US
Mailing Address - Phone:425-456-5933
Mailing Address - Fax:
Practice Address - Street 1:16401 SE 24TH ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98008-5432
Practice Address - Country:US
Practice Address - Phone:425-456-5933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-17
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA364157H103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool