Active NPI
Juanita K Doss, PHD
- Clinical Psychologist
- Southfield, MI
National Provider Identifier
1063579373
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 6301007150
- Practice address
- 17352 W 12 Mile Rd
Southfield, MI 48076 - Phone
- (248) 559-0730
- Fax
- (248) 569-7626
- NPI assigned
- Jan 3, 2007
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 6301007150 | MI | Primary |
Addresses
Primary practice location
17352 W 12 Mile Rd
Southfield, MI 48076
Mailing address
30740 Ivy Glen CT
Bingham Farms, MI 48025
Phone (248) 443-1430
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0F34599 | Other | MI | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6301007150 | MI | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Burdette and Doss Psychological Services LC | Clinical | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Southfield, MI
- NPI 1073647731
Clinical
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167782400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1063579373",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30740 IVY GLEN CT",
"city": "BINGHAM FARMS",
"state": "MI",
"postal_code": "48025",
"telephone_number": "248-443-1430",
"fax_number": "248-569-7626"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17352 W 12 MILE RD",
"city": "SOUTHFIELD",
"state": "MI",
"postal_code": "48076",
"telephone_number": "248-559-0730",
"fax_number": "248-569-7626"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOSS",
"first_name": "JUANITA",
"middle_name": "K",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MI",
"license": "6301007150",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "0F34599",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Southfield, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.