Active NPI
Douglas Bellamy, EDD
- Counseling Psychologist
- Dallas, TX
National Provider Identifier
1962533489
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counseling Psychologist
- License
- 21998
- Practice address
- 17762 Preston Rd
Dallas, TX 75252-5736 - Phone
- (972) 404-8888
- Fax
- (972) 208-2412
- NPI assigned
- Mar 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counseling Psychologist | 103TC1900X | 21998 | TX | Primary |
Addresses
Primary practice location
17762 Preston Rd
Dallas, TX 75252-5736
Mailing address
PO Box 940165
Plano, TX 75094-0165
Phone (972) 424-9212
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 038966001 | Medicaid | TX | |
| 4108749 | Other | TX | AETNA ID |
| 81618P | Other | TX | BLUE CROSS ID |
| 21998 | Other | TX | STATE LICENSE |
| OP21998 | Other | TX | WC ID |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21998 | TX | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173312000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1365120000000",
"number": "1962533489",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 940165",
"city": "PLANO",
"state": "TX",
"postal_code": "750940165",
"telephone_number": "972-424-9212",
"fax_number": "972-509-1450"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17762 PRESTON RD",
"city": "DALLAS",
"state": "TX",
"postal_code": "752525736",
"telephone_number": "972-404-8888",
"fax_number": "972-208-2412"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BELLAMY",
"first_name": "DOUGLAS",
"credential": "EDD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-08",
"last_updated": "2013-04-05",
"status": "A"
},
"taxonomies": [
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "TX",
"license": "21998",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "038966001",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA ID",
"identifier": "4108749",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS ID",
"identifier": "81618P",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "21998",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WC ID",
"identifier": "OP21998",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 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.