Individual provider Active NPI

Douglas Christian Nies, PH.D.

  • Clinical Psychologist
  • Glendale, CA
National Provider Identifier
1609091859
Registry record updated May 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY 8297 Issued in CA
Practice address
201 N Brand Blvd Unit 200
Glendale, CA 91203-3590
Phone
(818) 240-7454
NPI assigned
Apr 14, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 16, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PSY 8297 CA Primary
Clinical Neuropsychologist 103G00000X PSY 8297 CA

Addresses

Primary practice location

201 N Brand Blvd Unit 200
Glendale, CA 91203-3590

Mailing address

201 N Brand Blvd Unit 200
Glendale, CA 91203-3590
Phone (818) 240-7454

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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

Enrollment IDStateProvider typePAC IDDetails
I20120710000553 CA Practitioner - Clinical Psychologist 9335304716 Practice locations: Glendale, CA

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

201 N Brand Blvd
Unit 200
Glendale, CA 91203-3590
Phone (818) 240-7454

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
PSY 8297CAMDClinical Neuropsychologist
8297CAMDPediatric Occupational Therapist

NPI Registry JSON

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

{
    "created_epoch": "1176508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715817600000",
    "number": "1609091859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 N BRAND BLVD UNIT 200",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912033590",
            "telephone_number": "818-240-7454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 N BRAND BLVD UNIT 200",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912033590",
            "telephone_number": "818-240-7454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIES",
        "first_name": "DOUGLAS",
        "middle_name": "CHRISTIAN",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-14",
        "last_updated": "2024-05-16",
        "certification_date": "2021-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY 8297",
            "primary": true
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "CA",
            "license": "PSY 8297",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, CA

Sources for this page

Verify at the official NPI Registry.