Provider Demographics
NPI:1588856793
Name:MCQUEEN, DOUGLAS RUSH (PHD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:RUSH
Last Name:MCQUEEN
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 1:408 W TUSKEENA ST
Mailing Address - Street 2:
Mailing Address - City:WETUMPKA
Mailing Address - State:AL
Mailing Address - Zip Code:36092-2425
Mailing Address - Country:US
Mailing Address - Phone:334-399-3071
Mailing Address - Fax:
Practice Address - Street 1:408 W TUSKEENA ST
Practice Address - Street 2:
Practice Address - City:WETUMPKA
Practice Address - State:AL
Practice Address - Zip Code:36092-2425
Practice Address - Country:US
Practice Address - Phone:334-399-3071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-11
Last Update Date:2007-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1377103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical