Deandrea Michelle Douglas, JST

Primary specialty

Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X

License

DDOUGL73 Issued in TX

Practice address

239 W Tidwell Rd Ste F1
Houston, TX 77022-1528

Phone

(281) 248-6109

NPI assigned

Nov 9, 2020

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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.

• Graham Gatti Members Only Adult Care Club

  • Adult Day Care Clinic/Center
  • Houston, TX
  • NPI 1942685771
  NPD (past)

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

{
    "created_epoch": "1604880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604880000000",
    "number": "1952902686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1445 LAKESIDE ESTATES DR APT 2102",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770422490",
            "telephone_number": "281-248-6109",
            "fax_number": "281-715-5515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "239 W TIDWELL RD STE F1",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770221528",
            "telephone_number": "281-248-6109"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4505 Highway 6 N Ste 850",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "770843481",
            "country_code": "US",
            "telephone_number": "281-248-6109",
            "fax_number": "281-715-5515",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5309 Cavalcade St",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "770263943",
            "country_code": "US",
            "telephone_number": "281-248-6109",
            "fax_number": "281-715-5515",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6430 Court Rd Bldg A",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "770534462",
            "country_code": "US",
            "telephone_number": "281-248-6109",
            "fax_number": "281-715-5515",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DOUGLAS",
        "first_name": "DEANDREA",
        "middle_name": "MICHELLE",
        "credential": "JST",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-11-09",
        "last_updated": "2020-11-09",
        "certification_date": "2020-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "TX",
            "license": "DDOUGL73",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNT WISE VOCATIONAL SERVICES",
            "identifier": "DDOUGL73",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brian Douglas, M.D.
• Brittany Lauren Douglas, OTR/L, CHT
• Cheryl Lynn Douglas, RPH
• Dana Fox Douglas
• David G Douglas
• Denika Y Douglas, L.P., L.S.S.P.
• Diana Garcia Douglas, NP
• Gloria Denice Douglas, LPC
• Kimberly Deshay Douglas, MA, MBC
• Kord Douglas

• Developmentally Disabled Services Day Training Agency in Houston, TX
• Providers in Houston, TX by specialty
• Developmentally Disabled Services Day Training Agency in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.