Provider Demographics
NPI:1629062278
Name:GAUSS, DOUGLAS ALLAN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:ALLAN
Last Name:GAUSS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 344
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:TN
Mailing Address - Zip Code:38014-0344
Mailing Address - Country:US
Mailing Address - Phone:901-872-3525
Mailing Address - Fax:901-872-2610
Practice Address - Street 1:7864 HARROLD CV
Practice Address - Street 2:
Practice Address - City:MILLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38053-2400
Practice Address - Country:US
Practice Address - Phone:901-872-3525
Practice Address - Fax:901-872-2610
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNIP 6081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3006330OtherBCBSTN
TN3692737Medicare ID - Type Unspecified