Provider Demographics
NPI:1184017790
Name:DOUGLAS STEPHENS ED D PLLC
Entity Type:Organization
Organization Name:DOUGLAS STEPHENS ED D PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:B
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:518-222-0133
Mailing Address - Street 1:30 CHARTER ST
Mailing Address - Street 2:10
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-2343
Mailing Address - Country:US
Mailing Address - Phone:518-222-0133
Mailing Address - Fax:603-232-3079
Practice Address - Street 1:30 CHARTER ST
Practice Address - Street 2:10
Practice Address - City:EXETER
Practice Address - State:NH
Practice Address - Zip Code:03833-2343
Practice Address - Country:US
Practice Address - Phone:518-222-0133
Practice Address - Fax:603-232-3079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-07
Last Update Date:2015-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH15421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty