NPIMap

Organization Active NPI

Diane Johnson Prosser, PHD., LLC

  • Clinical Psychologist
  • South Bend, IN
National Provider Identifier
1508213844
Registry record updated May 17, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
20040993 Issued in IN
Legal business name
DIANE JOHNSON PROSSER, PHD., LLC
Practice address
227 N Dixie Way
Suite 110
South Bend, IN 46637-3385
Phone
(574) 850-8486
Fax
(574) 966-1580
NPI assigned
May 17, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 17, 2016

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

Authorized official

Name
Diane Johnson Prosser, HSPP
Title
Sole Proprietor
Phone
(574) 850-8486

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X 20040993 IN Primary

Addresses

Primary practice location

227 N Dixie Way
Suite 110
South Bend, IN 46637-3385

Mailing address

227 N Dixie Way
Suite 110
South Bend, IN 46637-3385
Phone (574) 850-8486

Other identifiers 1

IdentifierTypeStateIssuer
200122760AMedicaidIN

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1463443200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463443200000",
    "number": "1508213844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "227 N DIXIE WAY",
            "address_2": "SUITE 110",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466373385",
            "telephone_number": "574-850-8486",
            "fax_number": "574-966-1580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "227 N DIXIE WAY",
            "address_2": "SUITE 110",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466373385",
            "telephone_number": "574-850-8486",
            "fax_number": "574-966-1580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIANE JOHNSON PROSSER, PHD., LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-17",
        "last_updated": "2016-05-17",
        "status": "A",
        "authorized_official_last_name": "PROSSER",
        "authorized_official_first_name": "DIANE",
        "authorized_official_middle_name": "JOHNSON",
        "authorized_official_title_or_position": "SOLE PROPRIETOR",
        "authorized_official_telephone_number": "574-850-8486",
        "authorized_official_credential": "HSPP"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "IN",
            "license": "20040993",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200122760A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Bend, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 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.

Verify at the official NPI Registry.