Active NPI
Joanne King, PH.D.
- Counseling Psychologist
- Danville, IL
National Provider Identifier
1114977543
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counseling Psychologist
- License
- 20040950A
- Practice address
- 1900 East Main Street
PTSD Clinic (116a)
Danville, IL 61822 - Phone
- (217) 554-4257
- Fax
- (217) 554-4822
- NPI assigned
- May 10, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 20040950 | IN | |
| Counseling Psychologist | 103TC1900X | 20040950A | IN | Primary |
Addresses
Primary practice location
1900 East Main Street
PTSD Clinic (116a)
Danville, IL 61822
Mailing address
1900 East Main Street
PTSD Clinic (116a)
Danville, IL 61832
Phone (217) 554-4257
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200177930 | Medicaid | IN |
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20040950 | IN | MD | Clinical Psychologist |
| 20040950A | IN | MD | Counseling Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147219200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1464048000000",
"number": "1114977543",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1900 EAST MAIN STREET",
"address_2": "PTSD CLINIC (116A)",
"city": "DANVILLE",
"state": "IL",
"postal_code": "61832",
"telephone_number": "217-554-4257",
"fax_number": "217-554-4822"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1900 EAST MAIN STREET",
"address_2": "PTSD CLINIC (116A)",
"city": "DANVILLE",
"state": "IL",
"postal_code": "61822",
"telephone_number": "217-554-4257",
"fax_number": "217-554-4822"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KING",
"first_name": "JOANNE",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-10",
"last_updated": "2016-05-24",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IN",
"license": "20040950",
"primary": false
},
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "IN",
"license": "20040950A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200177930",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Danville, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.