NPI Code Detail JSON Logo

1073374989 NPI number — EPIR SOURCE MENTAL HEALTH SERVICES

NPI Number: 1073374989
Health Care Provider/Practitioner: EPIR SOURCE MENTAL HEALTH SERVICES

Information about “1073374989” NPI (EPIR SOURCE MENTAL HEALTH SERVICES) exists in 1073374989 in HTML format HTML  |  1073374989 in plain Text format TXT  |  1073374989 in PDF (Portable Document Format) PDF  |  1073374989 in an XML format XML  formats.

NPI Number : 1073374989 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1073374989",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "Y",
    "ParentOrgLBN": "EPIR SOURCE MENTAL HEALTH SERVICES",
    "ParentOrgTIN": null,
    "OrgName": "EPIR SOURCE MENTAL HEALTH SERVICES",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "819 AVONDALE DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SAINT PETERS",
    "MailingAddressStateName": "MO",
    "MailingAddressPostalCode": "63376-7835",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "314-485-9241",
    "MailingAddressFaxNumber": "314-255-2501",
    "FirstLinePracticeLocationAddress": "911 WASHINGTON AVE STE 501",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SAINT LOUIS",
    "PracticeLocationAddressStateName": "MO",
    "PracticeLocationAddressPostalCode": "63101-1272",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "314-485-9241",
    "PracticeLocationAddressFaxNumber": "314-255-2501",
    "EnumerationDate": "01/18/2024",
    "LastUpdateDate": "01/18/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "SMITH",
    "AuthorizedOfficialFirstName": "LATRECE",
    "AuthorizedOfficialMiddleName": "MARLENE",
    "AuthorizedOfficialTitle": "OWNER/OPERATOR",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "LCSW",
    "AuthorizedOfficialTelephoneNumber": "314-485-9241",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "101YM0800X",
        "TaxonomyName": "Mental Health Counselor",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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