Provider Demographics
NPI:1417144486
Name:DOUGLAS, UMAR (BA)
Entity Type:Individual
Prefix:
First Name:UMAR
Middle Name:
Last Name:DOUGLAS
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 GREENDALE WAY APT 3
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-1508
Mailing Address - Country:US
Mailing Address - Phone:408-417-2812
Mailing Address - Fax:
Practice Address - Street 1:455 SILICON VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95138-1858
Practice Address - Country:US
Practice Address - Phone:408-284-9010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-03
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor