Provider Demographics
NPI:1295506863
Name:DOUGLAS, BRITTA NICOLE (PLMHP)
Entity type:Individual
Prefix:
First Name:BRITTA
Middle Name:NICOLE
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 W 11TH ST
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-7336
Mailing Address - Country:US
Mailing Address - Phone:308-237-4085
Mailing Address - Fax:
Practice Address - Street 1:514 W 11TH ST
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-7336
Practice Address - Country:US
Practice Address - Phone:308-237-4085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13755101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health