Provider Demographics
NPI:1679011431
Name:DOUGLASS COUNSELING LLC
Entity Type:Organization
Organization Name:DOUGLASS COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:ELISSA
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:DOUGLASS
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-S
Authorized Official - Phone:614-499-5131
Mailing Address - Street 1:20 COURT ST
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-1405
Mailing Address - Country:US
Mailing Address - Phone:614-499-5131
Mailing Address - Fax:
Practice Address - Street 1:20 COURT ST
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-1405
Practice Address - Country:US
Practice Address - Phone:614-499-5131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.1200036.SUPV.251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health