Individual
DR. CASEY LEE MCDOUGALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D., L.P.
Contact information
Practice address
HWY 1 HOSPITAL DRIVE, BOX 497, RED LAKE, MN 56671
(218) 679-3912
(218) 679-0181
Mailing address
BOX 497, HWY 1 AVE, RED LAKE, MN 56671
(218) 679-3912
(218) 679-0181
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
LP 5341
MN
103TC0700X
Clinical Psychologist
Primary
LP 5341
MN
103TC2200X
Clinical Child & Adolescent Psychologist
LP 5341
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1508809765
—
MN
01
—
LP 5341
MN BOARD OF PSYCHOLOGY LICENSE #
MN
Enumeration date
12/13/2010
Last updated
07/11/2012
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