Active NPI
Michael Adam Douglas, PHD
- Clinical Psychologist
- Los Angeles, CA
National Provider Identifier
1073736559
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY 20495
- Practice address
- 6310 San Vicente Blvd
Suite 425
Los Angeles, CA 90048 - Phone
- (310) 405-1948
- NPI assigned
- Apr 11, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 | PSY 20495 | CA | Primary |
Addresses
Primary practice location
6310 San Vicente Blvd
Suite 425
Los Angeles, CA 90048
Mailing address
6310 San Vicente Blvd
Suite 425
Los Angeles, CA 90048
Phone (310) 405-1948
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)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY 20495 | CA | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Michael a. Douglas, PHD | 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 and National Provider Directory roles.
-
- Clinical Psychologist
- Los Angeles, CA
- NPI 1780824219
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176249600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1709683200000",
"number": "1073736559",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6310 SAN VICENTE BLVD",
"address_2": "SUITE 425",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "90048",
"telephone_number": "310-405-1948"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6310 SAN VICENTE BLVD",
"address_2": "SUITE 425",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "90048",
"telephone_number": "310-405-1948"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOUGLAS",
"first_name": "MICHAEL",
"middle_name": "ADAM",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-11",
"last_updated": "2024-03-06",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY 20495",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.