Provider Demographics
NPI:1881970531
Name:DOUGLAS, MARKUS T (LSW)
Entity type:Individual
Prefix:
First Name:MARKUS
Middle Name:T
Last Name:DOUGLAS
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 WESTCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:AUSTINTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-3965
Mailing Address - Country:US
Mailing Address - Phone:330-270-1400
Mailing Address - Fax:330-270-1404
Practice Address - Street 1:136 WESTCHESTER DR
Practice Address - Street 2:
Practice Address - City:AUSTINTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-3965
Practice Address - Country:US
Practice Address - Phone:330-270-1400
Practice Address - Fax:330-270-1404
Is Sole Proprietor?:No
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.0026089104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker