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General NPI Number Information
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NPI Number | 1629742978
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Entity Type | Individual
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Provider Name | ANN DOUGLAS PHD
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Gender | Female
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Dates
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Enumeration Date | 08/02/2021
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Last Update Date | 04/04/2025
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Provider Practice Location Address
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Address Line | 900 N ORANGE ST STE 202
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City | MISSOULA
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State | MT
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Zip | 59802-2951
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Country | US
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Telephone | 406-327-3362
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Fax | 406-327-3349
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Provider Business Mailing Address
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Address Line | PO BOX 31001-4110
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City | PASADENA
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State | CA
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Zip | 91110-4110
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Country | US
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Telephone | 406-327-3362
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Fax | 406-327-3349
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY-PSY-TMP-3549
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | BBH-LCPC-LIC-78437
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License Number State | MT
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