Organization
ROSCOE L. DOUGLAS, PH.D., P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROSCOE LORMER DOUGLAS PH.D. (CLINICAL PSYCHOLOGIST)
(601) 483-8370
Entity
Organization
Contact information
Practice address
1207 WHITE OAK DR, MERIDIAN, MS 39305-1902
(601) 483-8370
(601) 482-4248
Mailing address
PO BOX 3545, MERIDIAN, MS 39303-3545
(601) 483-8370
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
139
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00017960
—
MS
01
—
1740494434
NPI INDIV PROV NUMBER
MS
Enumeration date
06/11/2007
Last updated
08/22/2020
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