Provider Demographics
NPI:1154037067
Name:WILBUR, DOUGLAS R (MA, LPC-MHSP, NCC)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:R
Last Name:WILBUR
Suffix:
Gender:M
Credentials:MA, LPC-MHSP, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2596 N MOUNT JULIET RD
Mailing Address - Street 2:
Mailing Address - City:MT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-3170
Mailing Address - Country:US
Mailing Address - Phone:615-648-5199
Mailing Address - Fax:
Practice Address - Street 1:1102 DOW ST
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-2486
Practice Address - Country:US
Practice Address - Phone:615-704-7170
Practice Address - Fax:615-904-7288
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6104101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional