Southern, Douglas Stephen

Southern, Douglas Stephen is an individual health care provider with primary practice located at 104 E Linda Vista Blvd Ste B , Roswell NM 88201-6667. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Professional, Behavioral Health & Social Service Providers / Psychologist. Behavioral Health & Social Service Providers / Psychologist is his primary health care specialty. Southern, Douglas Stephen can be contacted via phone (575) 624-8889.

Contact Information

Primary practice address
104 E Linda Vista Blvd Ste B Roswell NM 88201-6667
Phone: (575) 624-8889
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Professional 101YP2500X 0128981 New Mexico
Behavioral Health & Social Service Providers / Psychologist 103T00000X 1353 New Mexico

Profile Details

NPI number 1043407190
LBN Legal business name Southern, Douglas Stephen
Credentials PHD
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 2nd, 2007
Last updated Apr 21st, 2017 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1043407190 NPPES
New Mexico MEDICAID 10180087

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