Active NPI
Robert Douk, LEP, BCBA-D
- School Psychologist
- Garden Grove, CA
National Provider Identifier
1457625295
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Psychologist
- License
- LEP3066
- Practice address
- 11358 Knott St.
Garden Grove, CA 92841 - Phone
- (800) 249-1266
- Fax
- (800) 385-8191
- NPI assigned
- Feb 24, 2012
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | BCBA-D 1-08-4069 | CA | |
| Psychologist | 103T00000X | LEP 3066 | CA | |
| School Psychologist | 103TS0200X | LEP3066 | CA | Primary |
Addresses
Primary practice location
11358 Knott St.
Garden Grove, CA 92841
Mailing address
11358 Knott St.
Garden Grove, CA 92841
Phone (800) 249-1266
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LEP 3066 | CA | MD | Psychologist |
| LEP3066 | CA | MD | School Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1330041600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1365638400000",
"number": "1457625295",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11358 KNOTT ST.",
"city": "GARDEN GROVE",
"state": "CA",
"postal_code": "92841",
"telephone_number": "800-249-1266",
"fax_number": "800-385-8191"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11358 KNOTT ST.",
"city": "GARDEN GROVE",
"state": "CA",
"postal_code": "92841",
"telephone_number": "800-249-1266",
"fax_number": "800-385-8191"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOUK",
"first_name": "ROBERT",
"name_prefix": "Dr.",
"credential": "LEP, BCBA-D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-02-24",
"last_updated": "2013-04-11",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "CA",
"license": "BCBA-D 1-08-4069",
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "LEP 3066",
"primary": false
},
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": "CA",
"license": "LEP3066",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Garden Grove, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.