Provider Demographics
NPI:1255087185
Name:DOUTHITT, JESSICA LAUREN (MA, LBS)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LAUREN
Last Name:DOUTHITT
Suffix:
Gender:F
Credentials:MA, LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 OLIVER ROAD
Mailing Address - Street 2:SUITE 116
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15431
Mailing Address - Country:US
Mailing Address - Phone:724-438-3011
Mailing Address - Fax:
Practice Address - Street 1:8 OLIVE ROAD
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401
Practice Address - Country:US
Practice Address - Phone:724-438-3011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH003230103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst