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1083080220 NPI number — SHELLEY MARIE KEEVEN LPC

NPI Number: 1083080220
Health Care Provider/Practitioner: SHELLEY MARIE KEEVEN LPC

Information about “1083080220” NPI (SHELLEY MARIE KEEVEN LPC) exists in 1083080220 in HTML format HTML  |  1083080220 in plain Text format TXT  |  1083080220 in PDF (Portable Document Format) PDF  |  1083080220 in an XML format XML  formats.

NPI Number : 1083080220 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1083080220",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "KEEVEN",
    "FirstName": "SHELLEY",
    "MiddleName": "MARIE",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "LPC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "SLATER",
    "OtherFirstName": "SHELLEY",
    "OtherMiddleName": "MARIE",
    "OtherNamePrefix": "MISS",
    "OtherNameSuffix": null,
    "OtherCredential": "LPC",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "7400 DEVONSHIRE AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SAINT LOUIS",
    "MailingAddressStateName": "MO",
    "MailingAddressPostalCode": "63119-2831",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "314-566-8864",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2811 S KINGSHIGHWAY BLVD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SAINT LOUIS",
    "PracticeLocationAddressStateName": "MO",
    "PracticeLocationAddressPostalCode": "63139-1006",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "314-802-8805",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/11/2015",
    "LastUpdateDate": "08/11/2015",
    "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": "101Y00000X",
        "TaxonomyName": "Counselor",
        "LicenseNumber": "2007027920",
        "LicenseNumberStateCode": "MO",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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