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NPI Code Detail

MEDICARE: ELIZABETH A DOUGLAS MA, LADC, LPCC

MEDICARE: ELIZABETH A DOUGLAS MA, LADC, LPCC
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
1101YA0400XAddiction (Substance Use Disorder) Counselor302188MN
2101YM0800XMental Health Counselor2409MN

General Provider Information

NPI Number : 1336439306
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH A DOUGLAS MA, LADC, LPCC
Provider Business Mailing Address
First Line : 11660 ROUND LAKE BLVD NW
Second Line :
City : COON RAPIDS
State : MN
Zip : 55433-2638
Country : US
Telephone Number : 763-439-4984
Fax Number : 763-767-0912
Provider Business Practice Location Address
First Line : 11660 ROUND LAKE BLVD NW
Second Line :
City : COON RAPIDS
State : MN
Zip : 55433-2638
Country : US
Telephone Number : 763-439-4984
Fax Number : 763-767-0912
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/12/2011
Last Update Date : 10/23/2023

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