Provider Demographics
NPI:1982762357
Name:DOUGLASS-EVERHARD, SUZYN MARY (MA)
Entity Type:Individual
Prefix:MS
First Name:SUZYN
Middle Name:MARY
Last Name:DOUGLASS-EVERHARD
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:SUZYN
Other - Middle Name:MARY
Other - Last Name:DOUGLASS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC, LPCC
Mailing Address - Street 1:495 ERLANGER RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ERLANGER
Mailing Address - State:KY
Mailing Address - Zip Code:41018-1468
Mailing Address - Country:US
Mailing Address - Phone:859-342-6444
Mailing Address - Fax:859-342-0999
Practice Address - Street 1:650 JOEL DR
Practice Address - Street 2:
Practice Address - City:FORT CAMPBELL
Practice Address - State:KY
Practice Address - Zip Code:42223-5318
Practice Address - Country:US
Practice Address - Phone:270-798-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-0854101YP2500X
TX64067101YP2500X
KY172576101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1982762357OtherNPI