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General NPI Number Information
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NPI Number | 1659401107
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Entity Type | Individual
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Provider Name | RICK D DOUGLAS LCSW
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Gender | Male
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 11/15/2012
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Provider Practice Location Address
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Address Line | 4411 KINSEY DR APT. 905
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City | TYLER
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State | TX
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Zip | 75703-1015
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Country | US
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Telephone | 903-273-2642
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Fax |
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Provider Business Mailing Address
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Address Line | 4411 KINSEY DR APT. 905
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City | TYLER
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State | TX
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Zip | 75703-1015
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Country | US
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Telephone | 903-273-2642
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 21438
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License Number State | TX
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