Patrice Nicole Douglas, LP, LMFT

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

34948 Issued in CA

Practice address

11175 Azusa CT Ste 110
Rancho Cucamonga, CA 91730-4933

Phone

(909) 705-0773

NPI assigned

May 11, 2015

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Thrive Psychological Services Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Ontario, CA
  • NPI 1528640026
  Medicare reassignment NPD
• Empire Family Counseling & Consultation

  • Marriage & Family Therapist
  • Rancho Cucamonga, CA
  • NPI 1518591155
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1431302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729036800000",
    "number": "1275911257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8350 ARCHIBALD AVE STE 100",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917303670",
            "telephone_number": "909-705-0773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11175 AZUSA CT STE 110",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917304933",
            "telephone_number": "909-705-0773"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4164 Brockton Ave",
            "address_purpose": "LOCATION",
            "city": "Riverside",
            "state": "CA",
            "postal_code": "925013400",
            "country_code": "US",
            "telephone_number": "951-683-5193 x331",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DOUGLAS",
        "first_name": "PATRICE",
        "middle_name": "NICOLE",
        "name_prefix": "Dr.",
        "credential": "LP, LMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-05-11",
        "last_updated": "2024-10-16",
        "certification_date": "2024-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "34948",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Donghan Kim, DDS Inc.
• Christina Dorantes
• Elizabeth Dossantos, D.O.
• Double Ace Home Health Services, Inc.
• Mia Douge
• Savannah Douglas
• Doulos Community Services
• Lailah Latranna Dow
• Andrea Marie Dowdy
• Dr Albert Lee DDS. Inc.

• Clinical Psychologist in Rancho Cucamonga, CA
• Providers in Rancho Cucamonga, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.