NPIMap

Organization Active NPI

Charles E. Davis, PH.D., P.C.

  • Clinical Psychologist
  • Oak Park, IL
National Provider Identifier
1619285269
Registry record updated Sep 16, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
071003271 Issued in IL
Legal business name
CHARLES E. DAVIS, PH.D., P.C.
Practice address
1010 Lake St
Suite 109
Oak Park, IL 60301-1147
Phone
(708) 431-2245
Fax
(708) 383-0198
NPI assigned
Sep 16, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2010

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

Authorized official

Name
Dr. Charles E. Davis, PH.D.
Title
President and Registered Agent
Phone
(708) 431-2245

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X 071003271 IL Primary

Addresses

Primary practice location

1010 Lake St
Suite 109
Oak Park, IL 60301-1147

Mailing address

1010 Lake St
Suite 109
Oak Park, IL 60301-1147
Phone (708) 431-2245

National Provider Directory

National Provider Directory

Locations

1010 Lake St
Ste 109
Oak Park, IL 60301
Phone (708) 431-2245

NPI Registry JSON

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

{
    "created_epoch": "1284595200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1284595200000",
    "number": "1619285269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1010 LAKE ST",
            "address_2": "SUITE 109",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603011147",
            "telephone_number": "708-431-2245",
            "fax_number": "708-383-0198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 LAKE ST",
            "address_2": "SUITE 109",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603011147",
            "telephone_number": "708-431-2245",
            "fax_number": "708-383-0198"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES E. DAVIS, PH.D., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-16",
        "last_updated": "2010-09-16",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "PRESIDENT AND REGISTERED AGENT",
        "authorized_official_telephone_number": "708-431-2245",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071003271",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oak Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2010; 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.