Provider Demographics
NPI:1366959751
Name:DOUGLAS, DEVON ELIZABETH (PSYD)
Entity type:Individual
Prefix:
First Name:DEVON
Middle Name:ELIZABETH
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:DEVON
Other - Middle Name:E
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6520 POE AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45414
Mailing Address - Country:US
Mailing Address - Phone:937-276-3356
Mailing Address - Fax:937-276-9514
Practice Address - Street 1:6520 POE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45414
Practice Address - Country:US
Practice Address - Phone:937-276-3356
Practice Address - Fax:937-276-9514
Is Sole Proprietor?:No
Enumeration Date:2018-01-07
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OHP.08167103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program