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General NPI Number Information
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NPI Number | 1427442607
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Entity Type | Individual
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Provider Name | AMY DOUGLASS LMFT
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Gender | Female
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Dates
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Enumeration Date | 03/25/2015
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Last Update Date | 08/05/2020
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Provider Practice Location Address
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Address Line | 1002 N 129TH INFANTRY DR STE F
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City | JOLIET
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State | IL
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Zip | 60435-3109
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Country | US
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Telephone | 815-823-8460
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Fax | 815-823-8461
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Provider Business Mailing Address
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Address Line | 2234 WILLOW RD
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City | HOMEWOOD
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State | IL
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Zip | 60430-3221
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Country | US
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Telephone | 708-539-9864
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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