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General NPI Number Information
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NPI Number | 1942575576
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Entity Type | Individual
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Provider Name | DOUGLAS BART THOMAS M.S., LPC
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Gender | Male
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Dates
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Enumeration Date | 03/15/2012
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Last Update Date | 08/15/2012
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Provider Practice Location Address
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Address Line | 2408 HERITAGE DR
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City | OPELIKA
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State | AL
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Zip | 36804-7610
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Country | US
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Telephone | 334-275-5405
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Fax | 334-737-0192
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Provider Business Mailing Address
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Address Line | 2408 HERITAGE DR
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City | OPELIKA
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State | AL
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Zip | 36804-7610
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Country | US
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Telephone | 334-275-5405
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Fax | 334-737-0192
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 1897
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License Number State | AL
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