MEDICARE: LUCY MARILYN DOUGLAS LMHC, ATR-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	00355	IA

General Provider Information

NPI Number	:	1053434928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCY MARILYN DOUGLAS LMHC, ATR-BC

Provider Business Mailing Address
First Line	:	2311 WARREN AVE
Second Line	:
City	:	SAINT CHARLES
State	:	IA
Zip	:	50240-8502
Country	:	US
Telephone Number	:	641-396-2703
Fax Number	:

Provider Business Practice Location Address
First Line	:	2311 WARREN AVE
Second Line	:
City	:	SAINT CHARLES
State	:	IA
Zip	:	50240-8502
Country	:	US
Telephone Number	:	641-396-2703
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2007
Last Update Date	:	07/08/2007

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