Provider Demographics
NPI:1760751705
Name:DOUGLAS, DENIKA Y (LP, LSSP)
Entity Type:Individual
Prefix:DR
First Name:DENIKA
Middle Name:Y
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:LP, LSSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12826 ASHFORD CHASE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-2105
Mailing Address - Country:US
Mailing Address - Phone:713-628-9131
Mailing Address - Fax:
Practice Address - Street 1:4801 WOODWAY DR
Practice Address - Street 2:SUITE 300E
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056-1884
Practice Address - Country:US
Practice Address - Phone:713-574-8502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-20
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35076103T00000X
TX34421103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool