Douglas J. Park, PH.D

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6301011777 Issued in MI

Practice address

2314 Monroe St
Dearborn, MI 48124-3010

Phone

(313) 565-5937

NPI assigned

Mar 24, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MI

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

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.

• The Guidance Center, Adult and Family Services

  • Professional Counselor
  • Southgate, MI
  • NPI 1306901178

  Clinical

  NPD (past)
• Wakefield Place Podiatry

  • Podiatrist
  • Wakefield, MA
  • NPI 1467406520
  NPD (past)

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

{
    "created_epoch": "1143158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1400457600000",
    "number": "1912967019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2314 MONROE ST",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481243010",
            "telephone_number": "313-565-5937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2314 MONROE ST",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481243010",
            "telephone_number": "313-565-5937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "DOUGLAS",
        "middle_name": "J.",
        "name_prefix": "Mr.",
        "credential": "PH.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-24",
        "last_updated": "2014-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301011777",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CARE NETWORK",
            "identifier": "680H216560",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "680H216560",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rachel Parent
• Acue Ernest Parham
• Vishal Parikh
• Marguerite Paris
• Kiara Jaylin Parisi
• Katen Park, MSW
• Stella Jane Park
• Courtney R Parker Jr.
• Jacqueline Ann Parker, ACNP
• Kelli Marie Parker

• Clinical Psychologist in Dearborn, MI
• Providers in Dearborn, MI by specialty
• Clinical Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2014; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.