Provider Demographics
NPI:1881867182
Name:DOUGLAS, GREG (LISW-S, CNP)
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:
Last Name:DOUGLAS
Suffix:
Gender:M
Credentials:LISW-S, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7341 S TIMBERLANE DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45243-1843
Mailing Address - Country:US
Mailing Address - Phone:513-793-3355
Mailing Address - Fax:
Practice Address - Street 1:7341 S TIMBERLANE DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45243-1843
Practice Address - Country:US
Practice Address - Phone:513-793-3355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-08
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.0700380-SUPV1041C0700X
OHCOA.17489-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical