Provider Demographics
NPI:1245596931
Name:DOUGLAS, QUINCY LEE
Entity Type:Individual
Prefix:MR
First Name:QUINCY
Middle Name:LEE
Last Name:DOUGLAS
Suffix:
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 1:2800 N THOMPKINS AVE
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:OK
Mailing Address - Zip Code:73008-4455
Mailing Address - Country:US
Mailing Address - Phone:405-361-2630
Mailing Address - Fax:
Practice Address - Street 1:2800 N THOMPKINS AVE
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:OK
Practice Address - Zip Code:73008-4455
Practice Address - Country:US
Practice Address - Phone:405-361-2630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-06
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst