Provider Demographics
NPI:1154835601
Name:DOUGLASS, JAMES THOMAS I (MS)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:THOMAS
Last Name:DOUGLASS
Suffix:I
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1423 PEGER RD
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-5169
Mailing Address - Country:US
Mailing Address - Phone:907-371-1300
Mailing Address - Fax:
Practice Address - Street 1:1423 PEGER RD
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-5169
Practice Address - Country:US
Practice Address - Phone:907-371-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-20
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health