Provider Demographics
NPI:1518323609
Name:DOUG CHISHOLM, LLC
Entity Type:Organization
Organization Name:DOUG CHISHOLM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:CHISHOLM
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC-S
Authorized Official - Phone:972-834-0770
Mailing Address - Street 1:8350 MEADOW RD
Mailing Address - Street 2:STE 198
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-3768
Mailing Address - Country:US
Mailing Address - Phone:972-834-0770
Mailing Address - Fax:
Practice Address - Street 1:8350 MEADOW RD
Practice Address - Street 2:STE 198
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-3768
Practice Address - Country:US
Practice Address - Phone:972-834-0770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-06
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65003101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty