Provider Demographics
NPI:1720433774
Name:DOUGLAS, SUSAN RAE (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:RAE
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2532 BLAIR BLVD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-4808
Mailing Address - Country:US
Mailing Address - Phone:615-423-0183
Mailing Address - Fax:
Practice Address - Street 1:6544 MURRAY LN
Practice Address - Street 2:THE DIAGNOSTIC CENTER AT CURREY INGRAM ACADEMY
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5515
Practice Address - Country:US
Practice Address - Phone:615-507-3171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP0000003182103TC0700X
MA7883103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical