NPI Code Detail JSON Logo

1033594775 NPI number — NAYIVE ELLIS LSCSW

NPI Number: 1033594775
Health Care Provider/Practitioner: NAYIVE ELLIS LSCSW

Information about “1033594775” NPI (NAYIVE ELLIS LSCSW) exists in 1033594775 in HTML format HTML  |  1033594775 in plain Text format TXT  |  1033594775 in PDF (Portable Document Format) PDF  |  1033594775 in an XML format XML  formats.

NPI Number : 1033594775 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1033594775",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ELLIS",
    "FirstName": "NAYIVE",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LSCSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "AVELAR",
    "OtherFirstName": "NAYIVE",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "LMSW",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "104 S. MAIN",
    "SecondLineMailingAddress": "PO BOX 637",
    "MailingAddressCityName": "JOHNSON",
    "MailingAddressStateName": "KS",
    "MailingAddressPostalCode": "67855-0637",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "620-952-1738",
    "MailingAddressFaxNumber": "620-492-3316",
    "FirstLinePracticeLocationAddress": "104 S. MAIN STREET",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "JOHNSON",
    "PracticeLocationAddressStateName": "KS",
    "PracticeLocationAddressPostalCode": "67855",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "620-952-1738",
    "PracticeLocationAddressFaxNumber": "620-492-3316",
    "EnumerationDate": "07/23/2015",
    "LastUpdateDate": "09/24/2018",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "104100000X",
          "TaxonomyName": "Social Worker",
          "LicenseNumber": "9639",
          "LicenseNumberStateCode": "KS",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1041C0700X",
          "TaxonomyName": "Clinical Social Worker",
          "LicenseNumber": "4766",
          "LicenseNumberStateCode": "KS",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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