DR. DYNESHA DIONE MASON-GRISSOM PH.D.
NPI 1043789688
Psychologist in Champaign, IL

Active since November 13, 2018PECOS Enrolled
2500 GALEN DR STE 104, CHAMPAIGN, IL 61821(217) 693-6072 Get Directions Write a Review

NPPES record last updated: January 21, 2020. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jan 21, 2020, Nov 13, 2018 (2 updates tracked since 2018).

About Dr. Dynesha Dione Mason-grissom Ph.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. DYNESHA DIONE MASON-GRISSOM PH.D. (NPI 1043789688) is an individual psychologist in Champaign, Illinois and active in the NPI registry since November 2018. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1043789688
Entity TypeIndividualFemale
Primary Taxonomy103T00000X
Provider Legal NameDR. DYNESHA DIONE MASON-GRISSOMCredential: PH.D.
Location Address2500 GALEN DR STE 104Champaign, IL 61821-7038
Mailing Address2500 Galen Dr Ste 104Champaign, IL 61821-7038 · (217) 693-6072
Sole ProprietorNo
Enumeration DateNovember 13, 2018
Last NPPES UpdateJanuary 21, 20202 updates tracked since enumeration
NPI 1043789688 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

Primary SpecialtyPsychologistBehavioral Health & Social Service Providers
Taxonomy Code103T00000X
Definition
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.
Also ListedPsychologist · CounselingTaxonomy 103TC1900X
Also ListedPsychologist · Clinical Child & AdolescentTaxonomy 103TC2200X
Also ListedPsychologist · FamilyTaxonomy 103TF0000X
2500 GALEN DR STE 104, Champaign, IL 61821

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Enrolled in Medicare (PECOS)

Dr. Dynesha Dione Mason-grissom Ph.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Counselor (Professional)
2500 GALEN DR STE 104
CHAMPAIGN, IL 61821

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Dynesha Mason-grissom's NPI number?

The NPI number for Dynesha Mason-grissom is 1043789688. It was assigned to this individual provider in the NPPES registry on November 13, 2018.

Where is Dynesha Mason-grissom located?

Dynesha Mason-grissom practices at 2500 Galen Dr Ste 104, Champaign, IL 61821. The listed phone number is (217) 693-6072.

What is Dynesha Mason-grissom's specialty?

The primary specialty registered for this NPI is Psychologist with taxonomy code 103T00000X.

Is Dynesha Mason-grissom enrolled in Medicare?

Yes. Dynesha Mason-grissom is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Dynesha Mason-grissom was last updated on January 21, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.