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1093550899 NPI number — ERIC WAYNE MCCLENDON BASW, BSC

NPI Number: 1093550899
Health Care Provider/Practitioner: ERIC WAYNE MCCLENDON BASW, BSC

Information about “1093550899” NPI (ERIC WAYNE MCCLENDON BASW, BSC) exists in 1093550899 in HTML format HTML  |  1093550899 in plain Text format TXT  |  1093550899 in PDF (Portable Document Format) PDF  |  1093550899 in an XML format XML  formats.

NPI Number : 1093550899 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1093550899",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MCCLENDON",
    "FirstName": "ERIC",
    "MiddleName": "WAYNE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "BASW, BSC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "350 FAIRWAY DR STE 101",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DEERFIELD BEACH",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "33441-1834",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "877-418-2978",
    "MailingAddressFaxNumber": "866-500-2186",
    "FirstLinePracticeLocationAddress": "700 MILAM ST STE 1300",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "HOUSTON",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "77002-2736",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "877-418-2978",
    "PracticeLocationAddressFaxNumber": "866-500-2186",
    "EnumerationDate": "06/25/2024",
    "LastUpdateDate": "06/25/2024",
    "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": "106S00000X",
        "TaxonomyName": "Behavior Technician",
        "LicenseNumber": null,
        "LicenseNumberStateCode": "TX",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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