NPIMap

Organization Active NPI

C Jesse Carlock PH D & Associates

  • Clinical Psychologist
  • Dayton, OH
National Provider Identifier
1801994199
Registry record updated Oct 13, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
C JESSE CARLOCK PH D & ASSOCIATES
Practice address
1105 Watervliet Ave
Dayton, OH 45420
Phone
(937) 256-0500
Fax
(937) 256-2136
NPI assigned
Sep 20, 2006
Last updated
Oct 13, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2009

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

Authorized official

Name
Ms. Charlene Jesse Carlock, PHDNPI 1902904295
Title
Owner /Psychologist
Phone
(937) 256-0500

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101YM0800X
Clinical PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103TC0700X Primary
Clinical Social WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1041C0700X

Addresses

Primary practice location

1105 Watervliet Ave
Dayton, OH 45420

Mailing address

1105 Watervliet Ave
Dayton, OH 45420
Phone (937) 256-0500

National Provider Directory

National Provider Directory

Locations

1105 Watervliet Ave
Dayton, OH 45420
Phone (937) 256-0500

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1255392000000",
    "number": "1801994199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1105 WATERVLIET AVE",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "45420",
            "telephone_number": "937-256-0500",
            "fax_number": "937-256-2136"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1105 WATERVLIET AVE",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "45420",
            "telephone_number": "937-256-0500",
            "fax_number": "937-256-2136"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "C JESSE CARLOCK PH D & ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2009-10-13",
        "status": "A",
        "authorized_official_last_name": "CARLOCK",
        "authorized_official_first_name": "CHARLENE",
        "authorized_official_middle_name": "JESSE",
        "authorized_official_title_or_position": "OWNER /PSYCHOLOGIST",
        "authorized_official_telephone_number": "937-256-0500",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dayton, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2009; 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.