MEDICARE: MRS. MONIQUE JUNE DOUGLAS LMFT

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	106H00000X	Marriage & Family Therapist	LMFT000073	DC

General Provider Information

NPI Number	:	1710204839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MONIQUE JUNE DOUGLAS LMFT

Provider Business Mailing Address
First Line	:	712 H ST NE # 1545
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20002-3627
Country	:	US
Telephone Number	:	202-329-1527
Fax Number	:

Provider Business Practice Location Address
First Line	:	712 H ST NE # 1545
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20002-3627
Country	:	US
Telephone Number	:	202-329-1527
Fax Number	:

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

Provider Enumeration Date	:	04/29/2010
Last Update Date	:	10/30/2020

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