Provider Demographics
NPI:1780981001
Name:DOUGLAS, JAMIE S (MA LMHC LMFTA ICACII)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:S
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:MA LMHC LMFTA ICACII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47933-3409
Mailing Address - Country:US
Mailing Address - Phone:765-376-3225
Mailing Address - Fax:
Practice Address - Street 1:304 S. PERRY ST
Practice Address - Street 2:
Practice Address - City:ATTICA
Practice Address - State:IN
Practice Address - Zip Code:47918
Practice Address - Country:US
Practice Address - Phone:765-762-0611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-23
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002241A101YM0800X
IN85000031A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist