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General NPI Number Information
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NPI Number | 1326236167
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Entity Type | Organization
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Legal Business Name | DOUGLAS R CHEATHAM
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Dates
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Enumeration Date | 10/05/2007
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Last Update Date | 06/13/2008
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Provider Practice Location Address
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Address Line | 1626 W HIGHWAY 287 BUSINESS SUITE #104
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City | WAXAHACHIE
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State | TX
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Zip | 75165-4712
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Country | US
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Telephone | 888-935-0027
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 190408
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City | DALLAS
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State | TX
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Zip | 75219-0408
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Country | US
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Telephone | 214-207-5664
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DOUGLAS RAY CHEATHAM
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Credential | PH.D.
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Telephone | 214-207-5664
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 11300
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 22513
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License Number State | TX
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