Provider Demographics
NPI:1619175783
Name:DOUD, ALICE P
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:P
Last Name:DOUD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 SHERMAN ST
Mailing Address - Street 2:
Mailing Address - City:STURGIS
Mailing Address - State:SD
Mailing Address - Zip Code:57785-1637
Mailing Address - Country:US
Mailing Address - Phone:605-490-2146
Mailing Address - Fax:
Practice Address - Street 1:928 LAZELLE ST
Practice Address - Street 2:
Practice Address - City:STURGIS
Practice Address - State:SD
Practice Address - Zip Code:57785-1674
Practice Address - Country:US
Practice Address - Phone:605-490-2146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD7240101YP2500X
SDLPC-MH 2304101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDLPC-MH 2304OtherDEPT. OF SOCIAL SERVICES- BOARD OF EXAMINERS FOR COUNSELORS AND MARRIAGE AND FAM