NPIMap

Organization Active NPI

Illinois State University

  • Clinical Psychologist
  • Normal, IL
National Provider Identifier
1770615502
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
ILLINOIS STATE UNIVERSITY
Doing business as
Psychological Services Center
Practice address
408 Fairchild Hall
Campus Box 4625
Normal, IL 61790
Phone
(309) 438-5629
Fax
(309) 438-7476
NPI assigned
Mar 9, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Brenda Jane Huber, PH.D.
Title
Clinical Psychologist
Phone
(309) 438-5629

Specialties & licenses 1

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

Addresses

Primary practice location

408 Fairchild Hall
Campus Box 4625
Normal, IL 61790

Mailing address

408 Fairchild Hall
Campus Box 4625
Normal, IL 61790
Phone (309) 438-5629

Other names 1

  • Psychological Services Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Illinois State University4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

408 Fairchild Hall
Normal, IL 61790
Phone (309) 438-5629

NPI Registry JSON

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

{
    "created_epoch": "1173398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1770615502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "408 FAIRCHILD HALL",
            "address_2": "CAMPUS BOX 4625",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "61790",
            "telephone_number": "309-438-5629",
            "fax_number": "309-438-7476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "408 FAIRCHILD HALL",
            "address_2": "CAMPUS BOX 4625",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "61790",
            "telephone_number": "309-438-5629",
            "fax_number": "309-438-7476"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLINOIS STATE UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HUBER",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_middle_name": "JANE",
        "authorized_official_title_or_position": "CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "309-438-5629",
        "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": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Psychological Services Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Normal, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.