Provider Demographics
NPI:1659625986
Name:DOUGLAS, AMBER ELIZABETH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:AMBER
Middle Name:ELIZABETH
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 BRAGG AVE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830
Mailing Address - Country:US
Mailing Address - Phone:334-734-2603
Mailing Address - Fax:334-887-0031
Practice Address - Street 1:124 BRAGG AVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830
Practice Address - Country:US
Practice Address - Phone:334-734-2603
Practice Address - Fax:334-887-0031
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-08
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1749103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL102I626774Medicare UPIN