Active NPI
Joanna Haversham, M.A.
- Mental Health Counselor
- Dyer, IN
National Provider Identifier
1609933340
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 1500030688
- Practice address
- 925 Killarney Dr
Dyer, IN 46311-1292 - Phone
- (773) 618-2231
- NPI assigned
- Jan 2, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 1500030688 | IL | Primary |
Addresses
Primary practice location
925 Killarney Dr
Dyer, IN 46311-1292
Mailing address
925 Killarney Dr
Dyer, IN 46311-1292
Phone (773) 618-2231
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
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1500030688 | IL | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| C.L.O. Psychological, Serv. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- Dyer, IN
- NPI 1447629142
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167696000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1765152000000",
"number": "1609933340",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "925 KILLARNEY DR",
"city": "DYER",
"state": "IN",
"postal_code": "463111292",
"telephone_number": "773-618-2231"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "925 KILLARNEY DR",
"city": "DYER",
"state": "IN",
"postal_code": "463111292",
"telephone_number": "773-618-2231"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAVERSHAM",
"first_name": "JOANNA",
"name_prefix": "Ms.",
"credential": "M.A.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-02",
"last_updated": "2025-12-08",
"certification_date": "2025-12-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "IL",
"license": "1500030688",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dyer, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.