Provider Demographics
NPI:1871023119
Name:DOUGLAS, LOIS (BHA)
Entity Type:Individual
Prefix:MRS
First Name:LOIS
Middle Name:
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:BHA
Other - Prefix:MISS
Other - First Name:LOIS
Other - Middle Name:
Other - Last Name:SHELDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BHA
Mailing Address - Street 1:PO BOX 256
Mailing Address - Street 2:
Mailing Address - City:KOTZEBUE
Mailing Address - State:AK
Mailing Address - Zip Code:99752-0256
Mailing Address - Country:US
Mailing Address - Phone:907-442-7640
Mailing Address - Fax:907-442-7749
Practice Address - Street 1:733 2ND AVE
Practice Address - Street 2:FRF BEHAVIORAL HEALTH SERVICE
Practice Address - City:KOTZEBUE
Practice Address - State:AK
Practice Address - Zip Code:99752-0256
Practice Address - Country:US
Practice Address - Phone:907-442-7640
Practice Address - Fax:907-442-7749
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-19
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty