Active NPI
Charles C. Anderson, ED.D
- Counseling Psychologist
- Arlington Heights, IL
National Provider Identifier
1609084342
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counseling Psychologist
- Practice address
- 3411 N Kennicott Ave
Ste B
Arlington Heights, IL 60004-7813 - Phone
- (847) 398-1717
- NPI assigned
- May 18, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 | IL | Primary |
Addresses
Primary practice location
3411 N Kennicott Ave
Ste B
Arlington Heights, IL 60004-7813
Mailing address
2030 N Magnolia Ave
Chicago, IL 60614-4010
Phone (847) 398-1717
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 |
|---|---|---|---|
| 071002741 | IL | MD | Counseling Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179446400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1609084342",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2030 N MAGNOLIA AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606144010",
"telephone_number": "847-398-1717"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3411 N KENNICOTT AVE",
"address_2": "STE B",
"city": "ARLINGTON HEIGHTS",
"state": "IL",
"postal_code": "600047813",
"telephone_number": "847-398-1717"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON",
"first_name": "CHARLES",
"middle_name": "C.",
"name_prefix": "Dr.",
"credential": "ED.D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Arlington Heights, IL
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.