Provider Demographics
NPI:1083003594
Name:BILLINGSLEY, DOUGLAS (LISW)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:BILLINGSLEY
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 153
Mailing Address - Street 2:
Mailing Address - City:EXLINE
Mailing Address - State:IA
Mailing Address - Zip Code:52555-0153
Mailing Address - Country:US
Mailing Address - Phone:563-370-6670
Mailing Address - Fax:
Practice Address - Street 1:208 N 12TH ST
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:IA
Practice Address - Zip Code:52544-1704
Practice Address - Country:US
Practice Address - Phone:563-370-6670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-21
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA008413104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker