Provider Demographics
NPI:1710026661
Name:STONE, DOUGLAS THOMAS JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:THOMAS
Last Name:STONE
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4241 E PIEDRAS DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228-1424
Mailing Address - Country:US
Mailing Address - Phone:210-736-1866
Mailing Address - Fax:210-736-1867
Practice Address - Street 1:4241 E PIEDRAS DR
Practice Address - Street 2:SUITE 250
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-1424
Practice Address - Country:US
Practice Address - Phone:210-736-1866
Practice Address - Fax:210-736-1867
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23809103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX032596101Medicaid
TXD10ROtherBCBS
TX00D10RMedicare ID - Type Unspecified