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General NPI Number Information
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NPI Number | 1154946168
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Entity Type | Individual
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Provider Name | TYMATHIE DOUGLAS
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Gender | Female
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Dates
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Enumeration Date | 06/15/2020
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Last Update Date | 11/16/2020
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Provider Practice Location Address
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Address Line | 4287 FIVE OAKS DR
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City | LANSING
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State | MI
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Zip | 48911-4214
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Country | US
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Telephone | 517-882-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 5208 W SAGINAW HWY PO BOX #81096
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City | LANSING
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State | MI
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Zip | 48917
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Country | US
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Telephone | 317-643-1014
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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