DR. DYNESHA DIONE MASON-GRISSOM (NPI# 1043789688) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043789688 |
| Entity Type | Individual |
| Full Name | DR. DYNESHA DIONE MASON-GRISSOM |
| Credential | PH.D. |
| Practice Address |
2500 Galen Dr Ste 104 Champaign IL 61821-7038 |
| Practice Telephone | 2176936072 |
| Mailing Telephone | 2176936072 |
| Enumeration Date | 2018-11-13 |
| Last Update Date | 2020-01-21 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103T00000X | Psychologist | Behavioral Health & Social Service Providers | ||
| N | 103TC1900X |
Psychologist Specialization: Counseling |
Behavioral Health & Social Service Providers | ||
| N | 103TC2200X |
Psychologist Specialization: Clinical Child & Adolescent |
Behavioral Health & Social Service Providers | ||
| N | 103TF0000X |
Psychologist Specialization: Family |
Behavioral Health & Social Service Providers |
| Street Address |
2500 GALEN DR STE 104 |
| City | CHAMPAIGN |
| State | IL |
| Zip Code | 61821-7038 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518509314 | Trese Mclaughlin | Counselor | 2500 Galen Dr Ste 104, Champaign, IL 61821-7038 | 2019-10-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326532888 | Cunningham Children's Home of Urbana Il | Residential Treatment Facility, Emotionally Disturbed Children | 1303 N. Cunningham Avenue, Urbana, IL 61821 | 2018-06-19 |
| 1184008708 | Seunghyun Jae | Dentist | 1905 W Springfield Ave, Champaign, IL 61821 | 2015-07-14 |
| 1457698169 | Mohamad Ata | Registered Nurse | 1802 S. Mattis, Champaign, IL 61821 | 2013-01-15 |
| 1609124338 | Lolitia Rosanna Newman | Social Worker | 1508 Powers Ln., Champaign, IL 61821 | 2012-08-28 |
| 1679850887 | Kirk Donald Gohsman | Counselor | 106 S. Country Fair Drive, Suite C, Champaign, IL 61821 | 2011-11-16 |
| 1598054777 | Delbert William Nelson Jr. | Psychiatry & Neurology | 2115 Galen Dr, Champaign, IL 61821 | 2011-03-28 |
| 1790946929 | Rdi Vein LLC | Clinic/Center | 2502 Galen Drive, Suite 101, Champaign, IL 61821 | 2008-06-20 |
| 1366620064 | Advanced Aesthetics Surgery & Laser Center, P.C. | Clinic/Center | 2111 West Park Ct., Champaign, IL 61821 | 2008-02-05 |
| 1033398482 | Huey's Home Medical, Inc | Durable Medical Equipment & Medical Supplies | 1207 S Mattis Ave Ste 1, Champaign, IL 61821 | 2007-11-01 |
| 1265630537 | Elizabeth Catherine Tingley | Psychologist | Department of Psychiatry and Psychology-carle Physician, 1802 S. Mattis, Champaign, IL 61821 | 2007-07-06 |
| Find all providers in zip 61821 | ||||
| Taxonomy Code | 103T00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public. |
| Notes: Source: American Psychological Association [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376165910 | Ji Yun Kang | Psychologist | 610 E John St Rm 236, Champaign, IL 61820-5717 | 2020-05-16 |
| 1518209030 | Lisa Kinderman | Psychologist | 801 Hessel Blvd, Champaign, IL 61820-6342 | 2013-03-22 |
| 1851663256 | Teresa L Davenport | Psychologist | 201 W Springfield Ave Ste 211, Champaign, IL 61820 | 2012-01-31 |
| 1023200326 | Kathryn Leskis | Psychologist | 301 N Neil St Ste 210, Champaign, IL 61820-3166 | 2007-08-10 |
| 1386777167 | Elaine Zeporah Jacobson | Psychologist | 1 Greencroft Dr, Champaign, IL 61821-5118 | 2007-03-13 |
| 1275642969 | Susan Elaine Minyard | Psychologist | 1701 South Prospect Avenue, Suite 8, Champaign, IL 61820-7050 | 2006-08-29 |
| 1780618595 | Joseph S Alper | Psychologist | 2008 Scottsdale Dr, Champaign, IL 61822-7641 | 2006-07-10 |
| 1003456369 | Rachael D Rubin | Psychologist | 1802 S Mattis Ave, Champaign, IL 61821-5923 | 2020-01-14 |
| 1558869081 | Kristin E Thies | Psychologist | 1802 S Mattis Ave, Champaign, IL 61821-5923 | 2018-01-30 |
| 1689018624 | Muge Dizen | Psychologist | 1813 W Kirby Ave, Champaign, IL 61821-5410 | 2013-04-22 |
| Find all providers in CHAMPAIGN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.