Marissa Lee Douglas, LMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

011838-01 Issued in NY

Practice address

300 West Ave
Brockport, NY 14420-1118

Phone

(585) 637-3905

NPI assigned

Feb 3, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NY

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

Specialty

Mental Health Counselor

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Oak Orchard Community Health Center, Inc.Group PAC ID 5496746927, 41 clinicians

Practice addresses (Care Compare)

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.

• Oak Orchard Community Health Center Inc.

  • Federally Qualified Health Center (FQHC)
  • Brockport, NY
  • NPI 1598707812
  Medicare reassignment Care Compare group NPD
• Oak Orchard Community Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Albion, NY
  • NPI 1407453244
  NPD
• Oak Orchard Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Medina, NY
  • NPI 1083357719
  NPD

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

{
    "created_epoch": "1643846400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643846400000",
    "number": "1417600982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1042 CLARKSON PARMA TL RD",
            "city": "HILTON",
            "state": "NY",
            "postal_code": "144689709",
            "telephone_number": "585-749-3274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 WEST AVE",
            "city": "BROCKPORT",
            "state": "NY",
            "postal_code": "144201118",
            "telephone_number": "585-637-3905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGLAS",
        "first_name": "MARISSA",
        "middle_name": "LEE",
        "credential": "LMHC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-02-03",
        "last_updated": "2022-02-03",
        "certification_date": "2022-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NY",
            "license": "011838-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mdouglas@oochc.org",
            "affiliation": "N",
            "address_1": "300 West Ave",
            "city": "Brockport",
            "state": "NY",
            "country_code": "US",
            "postal_code": "144201118",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Sarah B Dick, LPN
• Alyssa A Dimartino
• Doctor Hany G Nissiem Family Medicine PLLC
• Barbara A Dodson, LPN
• Kathleen A Donahue, PSYD
• Karissa Anne Dube, PHARMD
• Briana Dunton
• Joshua Adam Dvorak, DMD
• Jennifer Dys, RPH
• Elizabeth a. Cooley, LCSW, LLC

• Mental Health Counselor in Brockport, NY
• Providers in Brockport, NY by specialty
• Mental Health Counselor in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.