MEDICARE: JOHN DOUGLASS LPC

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	101YP2500X	Professional Counselor	2930	AL

General Provider Information

NPI Number	:	1336766757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN DOUGLASS LPC

Provider Business Mailing Address
First Line	:	2729 SOUTHVIEW TER
Second Line	:
City	:	VESTAVIA HILLS
State	:	AL
Zip	:	35216-2536
Country	:	US
Telephone Number	:	205-492-6328
Fax Number	:

Provider Business Practice Location Address
First Line	:	2729 SOUTHVIEW TER
Second Line	:
City	:	VESTAVIA HILLS
State	:	AL
Zip	:	35216-2536
Country	:	US
Telephone Number	:	205-492-6328
Fax Number	:

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

Provider Enumeration Date	:	07/01/2020
Last Update Date	:	07/01/2020

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