Provider Demographics
NPI:1720888480
Name:DOUGLAS, KAITLYN JOYCE (LPC)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:JOYCE
Last Name:DOUGLAS
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:J
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2520 VETERANS DR N
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON
Mailing Address - State:TN
Mailing Address - Zip Code:38344-6212
Mailing Address - Country:US
Mailing Address - Phone:731-415-3994
Mailing Address - Fax:
Practice Address - Street 1:2520 VETERANS DR N
Practice Address - Street 2:
Practice Address - City:HUNTINGDON
Practice Address - State:TN
Practice Address - Zip Code:38344-6212
Practice Address - Country:US
Practice Address - Phone:731-415-3994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7728101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health