Provider Demographics
NPI:1144250606
Name:COUNCIL, DOUGLAS (FNPC)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:COUNCIL
Suffix:
Gender:M
Credentials:FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 792
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:LA
Mailing Address - Zip Code:71221-0792
Mailing Address - Country:US
Mailing Address - Phone:318-283-8887
Mailing Address - Fax:318-281-6339
Practice Address - Street 1:335 MAIN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:LA
Practice Address - Zip Code:71260-5253
Practice Address - Country:US
Practice Address - Phone:318-283-8887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP03480363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1561479Medicaid