Provider Demographics
NPI:1568500296
Name:MCDOUGLE, ERIC SCOTT SR (MS, LMHP)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:SCOTT
Last Name:MCDOUGLE
Suffix:SR
Gender:M
Credentials:MS, LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7911 NEWPORT AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68122-1638
Mailing Address - Country:US
Mailing Address - Phone:402-813-1104
Mailing Address - Fax:
Practice Address - Street 1:5951 AMES AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68104-2705
Practice Address - Country:US
Practice Address - Phone:402-457-5761
Practice Address - Fax:402-457-1997
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2993 LMHP101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE85658OtherBCBSNE PROVIDER NUMBER
NE2993OtherLMHP