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General NPI Number Information
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NPI Number | 1477691418
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Entity Type | Individual
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Provider Name | DOUGLAS RAY CHEATHAM PH.D.
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Gender | Male
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 03/23/2010
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Provider Practice Location Address
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Address Line | 100 N COLLEGE SUITE 302
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City | WAXAHACHIE
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State | TX
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Zip | 75165-3702
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Country | US
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Telephone | 214-207-5664
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Fax | 888-765-7459
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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 | 888-765-7459
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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 | 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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