Provider Demographics
NPI:1760088488
Name:DOUGLAS, TASHA (MASTERS OF EDUCATION)
Entity Type:Individual
Prefix:
First Name:TASHA
Middle Name:
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:MASTERS OF EDUCATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 W GALVESTON ST UNIT 3265
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77574-1629
Mailing Address - Country:US
Mailing Address - Phone:409-655-1671
Mailing Address - Fax:409-750-7156
Practice Address - Street 1:240 W GALVESTON ST UNIT 3265
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77574-1629
Practice Address - Country:US
Practice Address - Phone:409-655-1671
Practice Address - Fax:409-750-7156
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral