Provider Demographics
NPI:1326015660
Name:STREICH, DOUGLAS DON (PHD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:DON
Last Name:STREICH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 EAST JEFFERSON BLVD.
Mailing Address - Street 2:SUITE 500
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601-1914
Mailing Address - Country:US
Mailing Address - Phone:574-232-4453
Mailing Address - Fax:574-232-7718
Practice Address - Street 1:105 EAST JEFFERSON BLVD.
Practice Address - Street 2:SUITE 500
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1914
Practice Address - Country:US
Practice Address - Phone:574-232-4453
Practice Address - Fax:574-232-7718
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040374103TC0700X
IN20040374A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200008780AMedicaid
IN200008780AMedicaid
IN237590KMedicare ID - Type Unspecified