NPIMap

Organization Active NPI

Eastland Psychological Services, LTD.

  • Clinical Psychologist
  • Bloomington, IL
National Provider Identifier
1194795344
Registry record updated Mar 12, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
71-3664 Issued in IL
Legal business name
EASTLAND PSYCHOLOGICAL SERVICES, LTD.
Practice address
1505 Eastland Dr
Emp II, Suite LL-1000
Bloomington, IL 61701-3534
Phone
(309) 663-1623
NPI assigned
Jan 23, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2008

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

Authorized official

Name
Dr. Mel French, PSY.D.
Title
Executive Director
Phone
(309) 663-1623

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X 71-3664 IL Primary

Addresses

Primary practice location

1505 Eastland Dr
Emp II, Suite LL-1000
Bloomington, IL 61701-3534

Mailing address

Emp II, Suite LL-1000
1505 Eastland Drive
Bloomington, IL 61701
Phone (309) 663-1623

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1137974400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205280000000",
    "number": "1194795344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "EMP II, SUITE LL-1000",
            "address_2": "1505 EASTLAND DRIVE",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "61701",
            "telephone_number": "309-663-1623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1505 EASTLAND DR",
            "address_2": "EMP II, SUITE LL-1000",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617013534",
            "telephone_number": "309-663-1623"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTLAND PSYCHOLOGICAL SERVICES, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-23",
        "last_updated": "2008-03-12",
        "status": "A",
        "authorized_official_last_name": "FRENCH",
        "authorized_official_first_name": "MEL",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "309-663-1623",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "71-3664",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomington, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2008; 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.