Provider Demographics
NPI:1710188321
Name:DOUGLASS, ELIZABETH JONES (MSW,MAED,LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:JONES
Last Name:DOUGLASS
Suffix:
Gender:F
Credentials:MSW,MAED,LCSW
Other - Prefix:MRS
Other - First Name:BETSY
Other - Middle Name:JONES
Other - Last Name:DOUGLASS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW MAED LCSW
Mailing Address - Street 1:41 BRIARCLIFF
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63124-1753
Mailing Address - Country:US
Mailing Address - Phone:314-432-1712
Mailing Address - Fax:
Practice Address - Street 1:77 WEST PORT PLAZA DRIVE
Practice Address - Street 2:SUITE 360
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146
Practice Address - Country:US
Practice Address - Phone:314-432-1462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0036101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical