Puran Douglass, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

0810004653 Issued in VA

Practice address

8233 Old Courthouse Rd Ste 102
Vienna, VA 22182-3816

Phone

(703) 924-2370

Fax

(703) 924-2374

NPI assigned

Oct 4, 2012

Last updated

Jan 2, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Metro Behavioral Health Services

  • Psychiatry Physician
  • Alexandria, VA
  • NPI 1578873469
  NPD (past)
• Modern Psychological Services LLC

  • Adult Mental Health Clinic/Center
  • Alexandria, VA
  • NPI 1902159122
  NPD (past)

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

{
    "created_epoch": "1349308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704153600000",
    "number": "1417209164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8233 OLD COURTHOUSE RD STE 102",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221823816",
            "telephone_number": "703-924-2370",
            "fax_number": "703-924-2374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8233 OLD COURTHOUSE RD STE 102",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221823816",
            "telephone_number": "703-924-2370",
            "fax_number": "703-924-2374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGLASS",
        "first_name": "PURAN",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-10-04",
        "last_updated": "2024-01-02",
        "certification_date": "2024-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TA0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "VA",
            "license": "0810004653",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "VA",
            "license": "0810004653",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deborah Donohue, RN
• Kelley C Donovan, LCSW
• Paula M Donovan, MA., MSW, LCSW
• Mike Doon
• Anaika Dorvilien, CRNP, FNP-C
• Lindsey Taylor Doyle, M.A., LPC
• Dr K Nutrition
• Dr Kallas Dental Center PLC
• Dr N Hines & T Fahy (Cardinal Podiatry)
• Dr Rader Advanced PT LLC

• Clinical Psychologist in Vienna, VA
• Providers in Vienna, VA by specialty
• Clinical Psychologist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 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.

Verify at the official NPI Registry.