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General NPI Number Information
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NPI Number | 1538859079
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Entity Type | Organization
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Legal Business Name | BRANDON DOUGLAS, LCPC, PLLC
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Dates
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Enumeration Date | 05/09/2023
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Last Update Date | 07/03/2023
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Provider Practice Location Address
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Address Line | 8 HERITAGE PLAZA
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City | BOURBONNAIS
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State | IL
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Zip | 60914
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Country | US
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Telephone | 309-706-4989
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Fax |
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Provider Business Mailing Address
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Address Line | 6933 175TH ST
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City | TINLEY PARK
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State | IL
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Zip | 60477-3826
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Country | US
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Telephone | 309-706-4989
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Fax |
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | BRANDON DOUGLAS
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Credential | LCPC
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Telephone | 309-706-4989
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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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