Active NPI
Charles John Dahlstrom, PH.D..
- Psychologist
- Warrensburg, MO
National Provider Identifier
1124160072
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PY01749
- Practice address
- 131 Humphreys
University of Central Missouri
Warrensburg, MO 64093 - Phone
- (660) 543-4060
- NPI assigned
- Feb 13, 2007
- Last updated
- Jul 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | PY01749 | MO | Primary |
Addresses
Primary practice location
131 Humphreys
University of Central Missouri
Warrensburg, MO 64093
Mailing address
131 Humphreys
University of Central Missouri
Warrensburg, MO 64093
Phone (660) 543-4060
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)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY01749 | MO | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171324800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1124160072",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "131 HUMPHREYS",
"address_2": "UNIVERSITY OF CENTRAL MISSOURI",
"city": "WARRENSBURG",
"state": "MO",
"postal_code": "64093",
"telephone_number": "660-543-4060"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "131 HUMPHREYS",
"address_2": "UNIVERSITY OF CENTRAL MISSOURI",
"city": "WARRENSBURG",
"state": "MO",
"postal_code": "64093",
"telephone_number": "660-543-4060"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAHLSTROM",
"first_name": "CHARLES",
"middle_name": "JOHN",
"credential": "PH.D..",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-13",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MO",
"license": "PY01749",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Warrensburg, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.