Provider Demographics
NPI:1659842433
Name:DOUGLASS ENTERPRISES LLC
Entity Type:Organization
Organization Name:DOUGLASS ENTERPRISES LLC
Other - Org Name:GOAL DRIVEN COUNSELING LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOUGLASS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:314-699-4216
Mailing Address - Street 1:PO BOX 125
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63032-0125
Mailing Address - Country:US
Mailing Address - Phone:314-699-4216
Mailing Address - Fax:
Practice Address - Street 1:1855 CHATEAU DU MONT DR
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-1053
Practice Address - Country:US
Practice Address - Phone:314-699-4216
Practice Address - Fax:949-404-6130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-05
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty