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1043774466 NPI number — WILLIAM EVANS LPC

NPI Number: 1043774466
Health Care Provider/Practitioner: WILLIAM EVANS LPC

Information about “1043774466” NPI (WILLIAM EVANS LPC) exists in 1043774466 in HTML format HTML  |  1043774466 in plain Text format TXT  |  1043774466 in PDF (Portable Document Format) PDF  |  1043774466 in an XML format XML  formats.

NPI Number : 1043774466 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1043774466",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "EVANS",
    "FirstName": "WILLIAM",
    "MiddleName": null,
    "NamePrefix": "MR.",
    "NameSuffix": null,
    "Credential": "LPC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3379 KINGS RIVER ST SW",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WYOMING",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "49418-8822",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "616-307-6855",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "5445 32ND AVE STE 180",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "HUDSONVILLE",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "49426-2408",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "616-307-6855",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/30/2019",
    "LastUpdateDate": "07/25/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "101Y00000X",
          "TaxonomyName": "Counselor",
          "LicenseNumber": "N352059",
          "LicenseNumberStateCode": "MI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": "6401222320",
          "LicenseNumberStateCode": "MI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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