Carissa Marie Douglas, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

32327 Issued in CA

Practice address

41197 Golden Gate Cir Ste 206
Murrieta, CA 92562-6999

Phone

(951) 394-3227

NPI assigned

Sep 19, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Apr 19, 2022 through Apr 19, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1190160000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612483200000",
    "number": "1508052986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41197 GOLDEN GATE CIR STE 206",
            "city": "MURRIETA",
            "state": "CA",
            "postal_code": "925626999",
            "telephone_number": "951-394-3227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "41197 GOLDEN GATE CIR STE 206",
            "city": "MURRIETA",
            "state": "CA",
            "postal_code": "925626999",
            "telephone_number": "951-394-3227"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "940 Avenue 64",
            "address_purpose": "LOCATION",
            "city": "Pasadena",
            "state": "CA",
            "postal_code": "911052711",
            "country_code": "US",
            "telephone_number": "323-254-2274",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DOUGLAS",
        "first_name": "CARISSA",
        "middle_name": "MARIE",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-09-19",
        "last_updated": "2021-02-05",
        "certification_date": "2021-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "32327",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Todd Alan Donohoe, D.C., D.I.C.C.P.
• Achala Bhaskara Doraiswamy, MD
• Samantha Doran
• Junise Jean-Gilles Dorestin, CLINICAL THERAPIST
• David A Dortch, OD
• Coley S Douglass, CPM
• Nadine Douhal
• Doulas of California
• Dr Kamran Ghoreyshi a Professional Dental Corporation
• Dr Lily Phillips MD Medical Group

• Clinical Psychologist in Murrieta, CA
• Providers in Murrieta, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2021; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.