Individual
DR. DOUGLASS EUGENE MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ED.D.
Contact information
Practice address
4013 NE 57TH PL, GLADSTONE, MO 64119-2268
(816) 536-1828
(816) 413-5305
Mailing address
4013 NE 57TH PL, GLADSTONE, MO 64119-2268
(816) 536-1828
(816) 413-5305
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PY000307
MO
103TA0400X
Addiction (Substance Use Disorder) Psychologist
PY000307
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16469011
BC/BS PROVIDER #
MO
Enumeration date
11/01/2006
Last updated
01/20/2010
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