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1083392302 NPI number — DISRUPTIVE THERAPY COLLECTIVE FOR THE INDIVIDUAL, FAMILY, AND CHILD, INC.

NPI Number: 1083392302
Health Care Provider/Practitioner: DISRUPTIVE THERAPY COLLECTIVE FOR THE INDIVIDUAL, FAMILY, AND CHILD, INC.

Information about “1083392302” NPI (DISRUPTIVE THERAPY COLLECTIVE FOR THE INDIVIDUAL, FAMILY, AND CHILD, INC.) exists in 1083392302 in HTML format HTML  |  1083392302 in plain Text format TXT  |  1083392302 in PDF (Portable Document Format) PDF  |  1083392302 in an XML format XML  formats.

NPI Number : 1083392302 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1083392302",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "DISRUPTIVE THERAPY COLLECTIVE FOR THE INDIVIDUAL, FAMILY, AND CHILD, INC.",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1769 PARK AVE STE 250",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SAN JOSE",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "95126-2030",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "408-365-4238",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1769 PARK AVE STE 250",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SAN JOSE",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "95126-2030",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "408-365-4238",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/06/2023",
    "LastUpdateDate": "04/23/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "BUI",
    "AuthorizedOfficialFirstName": "ALICE",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "CEO",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "LMFT",
    "AuthorizedOfficialTelephoneNumber": "408-365-4238",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261QM0801X",
        "TaxonomyName": "Mental Health Clinic/Center (Including Community Mental Health Center)",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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