Provider Demographics
NPI:1598877979
Name:DOUGLASS, LOUIS OWEN (PHD)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:OWEN
Last Name:DOUGLASS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:LUKE
Other - Middle Name:OWEN
Other - Last Name:DOUGLASS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:471 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-6236
Mailing Address - Country:US
Mailing Address - Phone:207-577-0002
Mailing Address - Fax:
Practice Address - Street 1:471 MAIN ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-6236
Practice Address - Country:US
Practice Address - Phone:207-577-0002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS1110103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist