Maryellen Dougherty

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PY60664588 Issued in WA

Practice address

13620 NE 20TH St Ste I
Bellevue, WA 98005-4901

Phone

(425) 647-7695

NPI assigned

Sep 17, 2014

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Hurley Medical Center

  • Adult Mental Health Clinic/Center
  • Flint, MI
  • NPI 1316383706
  NPD (past)
• Hurley Medical Center

  • Clinical Psychologist
  • Flint, MI
  • NPI 1750714275
  NPD (past)

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

{
    "created_epoch": "1410912000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691366400000",
    "number": "1295137610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13620 NE 20TH ST STE I",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980054901",
            "telephone_number": "425-647-7695"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13620 NE 20TH ST STE I",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980054901",
            "telephone_number": "425-647-7695"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2700 Robert T Longway Blvd",
            "address_2": "Suite 1",
            "address_purpose": "LOCATION",
            "city": "Flint",
            "state": "MI",
            "postal_code": "485032190",
            "country_code": "US",
            "telephone_number": "810-262-2320",
            "fax_number": "810-239-1281",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DOUGHERTY",
        "first_name": "MARYELLEN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-09-17",
        "last_updated": "2023-08-07",
        "certification_date": "2023-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "WA",
            "license": "PY60664588",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joseph W Doucette, M.D.
• Doug Bartholomew Ms Inc.
• Keivencia Pelia Anne Myrtel Douge
• Connor James Dougherty, DPT
• Kendall Dougherty, OTR/L
• Claire Douglas, OT
• Molly Douglas
• Akilina Douthat, LMT
• Maury Douthit Jr.
• Kathryn Dove

• Psychologist in Bellevue, WA
• Providers in Bellevue, WA by specialty
• Psychologist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.