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1053601724 NPI number — FOREST TU PAVEL PSY.D.

NPI Number: 1053601724
Health Care Provider/Practitioner: FOREST TU PAVEL PSY.D.

Information about “1053601724” NPI (FOREST TU PAVEL PSY.D.) exists in 1053601724 in HTML format HTML  |  1053601724 in plain Text format TXT  |  1053601724 in PDF (Portable Document Format) PDF  |  1053601724 in an XML format XML  formats.

NPI Number : 1053601724 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1053601724",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PAVEL",
    "FirstName": "FOREST",
    "MiddleName": "TU",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "PSY.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1816 NW 63RD TER",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "KANSAS CITY",
    "MailingAddressStateName": "MO",
    "MailingAddressPostalCode": "64151-4826",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "540-421-2357",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1301 N WAREHOUSE RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FORT LEAVENWORTH",
    "PracticeLocationAddressStateName": "KS",
    "PracticeLocationAddressPostalCode": "66027",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "913-758-3757",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/14/2011",
    "LastUpdateDate": "06/19/2022",
    "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": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": "6192",
          "LicenseNumberStateCode": "CO",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "103TC0700X",
          "TaxonomyName": "Clinical Psychologist",
          "LicenseNumber": "2022013155",
          "LicenseNumberStateCode": "MO",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "103TC0700X",
          "TaxonomyName": "Clinical Psychologist",
          "LicenseNumber": "03100",
          "LicenseNumberStateCode": "KS",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "103TC0700X",
          "TaxonomyName": "Clinical Psychologist",
          "LicenseNumber": "0810005068",
          "LicenseNumberStateCode": "VA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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