MEDICARE: BARBARA JEAN DOUGLASS LCSW

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	104100000X	Social Worker	2005019882	MO

General Provider Information

NPI Number	:	1063462091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARBARA JEAN DOUGLASS LCSW

Provider Business Mailing Address
First Line	:	PO BOX 803919
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64180-3919
Country	:	US
Telephone Number	:	660-885-8131
Fax Number	:

Provider Business Practice Location Address
First Line	:	3016 DUPONT CIR
Second Line	:
City	:	JEFFERSON CITY
State	:	MO
Zip	:	65109-6188
Country	:	US
Telephone Number	:	888-403-1071
Fax Number	:

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

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	10/01/2018

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