Provider Demographics
NPI:1861990723
Name:LOBO, DOUGLASS ADRIEN (LMHC)
Entity type:Individual
Prefix:DR
First Name:DOUGLASS
Middle Name:ADRIEN
Last Name:LOBO
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4924 MEDORAS AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-7170
Mailing Address - Country:US
Mailing Address - Phone:305-803-7528
Mailing Address - Fax:
Practice Address - Street 1:4924 MEDORAS AVE
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-7170
Practice Address - Country:US
Practice Address - Phone:305-803-7528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-25
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH-4113101YP2500X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional