Individual
KATHRYN ANNE DOUGLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA, LCPC, LPCC
Contact information
Practice address
535 MAINE ST, QUINCY, IL 62301-3950
(217) 577-2176
Mailing address
2909 SELKIRK LN, QUINCY, IL 62305-6525
(415) 580-0239
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YP2500X
Professional Counselor
13837
CA
101YP2500X
Professional Counselor
180007537
IL
101YP2500X
Professional Counselor
2009032566
MO
103K00000X
Behavior Analyst
Primary
1-19-35663
IL
Other
Enumeration date
09/12/2006
Last updated
10/17/2023
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