Provider Demographics
NPI:1871652248
Name:SCAMBLER, DOUGLAS JOHN (PHD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:JOHN
Last Name:SCAMBLER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 S 4TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-3753
Mailing Address - Country:US
Mailing Address - Phone:307-460-0120
Mailing Address - Fax:307-742-4089
Practice Address - Street 1:507 S 4TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-3753
Practice Address - Country:US
Practice Address - Phone:307-460-0120
Practice Address - Fax:307-742-4089
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK965103TC0700X, 103TC2200X, 103TM1800X
WY448103TC0700X, 103TC2200X, 103TB0200X, 103TM1800X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy