Healthcare Provider Details

I. General information

NPI: 1629062278
Provider Name (Legal Business Name): DOUGLAS ALLAN GAUSS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7864 HARROLD CV
MILLINGTON TN
38053-2400
US

IV. Provider business mailing address

PO BOX 344
BRUNSWICK TN
38014-0344
US

V. Phone/Fax

Practice location:
  • Phone: 901-872-3525
  • Fax: 901-872-2610
Mailing address:
  • Phone: 901-872-3525
  • Fax: 901-872-2610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberIP 608
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: