Provider Demographics
NPI:1306684923
Name:DOUGLAS, JENNIFER (LMSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:BURTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:535 S HUMBOLDT ST
Mailing Address - Street 2:
Mailing Address - City:BATTLE MOUNTAIN
Mailing Address - State:NV
Mailing Address - Zip Code:89820-1988
Mailing Address - Country:US
Mailing Address - Phone:775-635-2424
Mailing Address - Fax:
Practice Address - Street 1:535 S HUMBOLDT ST
Practice Address - Street 2:
Practice Address - City:BATTLE MOUNTAIN
Practice Address - State:NV
Practice Address - Zip Code:89820-1988
Practice Address - Country:US
Practice Address - Phone:775-635-2424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10342-M104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker