Provider Demographics
NPI:1972307411
Name:LEGRIS, DOUG (MA)
Entity type:Individual
Prefix:
First Name:DOUG
Middle Name:
Last Name:LEGRIS
Suffix:
Gender:
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 NOTCH RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLESEX
Mailing Address - State:VT
Mailing Address - Zip Code:05602-8784
Mailing Address - Country:US
Mailing Address - Phone:802-309-5411
Mailing Address - Fax:
Practice Address - Street 1:149 STATE ST
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-2965
Practice Address - Country:US
Practice Address - Phone:802-309-5411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0136504101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health