Active NPI
Charlene M Johnson
- Clinical Psychologist
- Danville, IL
National Provider Identifier
1730897505
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 20043627B
- Practice address
- 1900 E Main St
Danville, IL 61832-5100 - Phone
- (217) 554-4257
- NPI assigned
- Nov 10, 2022
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 20043627B | IN | Primary |
Addresses
Primary practice location
1900 E Main St
Danville, IL 61832-5100
Mailing address
7809 N 28TH 1/2 St
Terre Haute, IN 47805-1031
Phone (812) 236-8445
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20043627B | IN | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1668038400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1668038400000",
"number": "1730897505",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7809 N 28TH 1/2 ST",
"city": "TERRE HAUTE",
"state": "IN",
"postal_code": "478051031",
"telephone_number": "812-236-8445"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1900 E MAIN ST",
"city": "DANVILLE",
"state": "IL",
"postal_code": "618325100",
"telephone_number": "217-554-4257"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "CHARLENE",
"middle_name": "M",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-11-10",
"last_updated": "2022-11-10",
"certification_date": "2022-11-10",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IN",
"license": "20043627B",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Danville, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.