Provider Demographics
NPI:1538948187
Name:DOUGLAS, MARGARET ELLEN
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:ELLEN
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 RIDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68005-4745
Mailing Address - Country:US
Mailing Address - Phone:402-707-6209
Mailing Address - Fax:
Practice Address - Street 1:402 RIDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005-4745
Practice Address - Country:US
Practice Address - Phone:402-707-6209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-25
Last Update Date:2023-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13618101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health