MEDICARE: MRS. STEPHANIE DAYLE DOUGLAS MA LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MH9866	FL

General Provider Information

NPI Number	:	1184924649
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STEPHANIE DAYLE DOUGLAS MA LMHC

Provider Business Mailing Address
First Line	:	197 SW SARAH CT
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32024-3852
Country	:	US
Telephone Number	:	386-623-5732
Fax Number	:

Provider Business Practice Location Address
First Line	:	197 SW SARAH CT
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32024-3852
Country	:	US
Telephone Number	:	386-623-5732
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/29/2010
Last Update Date	:	10/29/2010

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