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1104565944 NPI number — KALEA DAION ELLIOTT CHW, MHPS

NPI Number: 1104565944
Health Care Provider/Practitioner: KALEA DAION ELLIOTT CHW, MHPS

Information about “1104565944” NPI (KALEA DAION ELLIOTT CHW, MHPS) exists in 1104565944 in HTML format HTML  |  1104565944 in plain Text format TXT  |  1104565944 in PDF (Portable Document Format) PDF  |  1104565944 in an XML format XML  formats.

NPI Number : 1104565944 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1104565944",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ELLIOTT",
    "FirstName": "KALEA",
    "MiddleName": "DAION",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "CHW, MHPS",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 211631",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BEDFORD",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "76095-8631",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "972-665-8944",
    "MailingAddressFaxNumber": "855-282-5709",
    "FirstLinePracticeLocationAddress": "1903 CENTRAL DR STE 301",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BEDFORD",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "76021-5813",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "682-777-5299",
    "PracticeLocationAddressFaxNumber": "855-282-5709",
    "EnumerationDate": "05/31/2022",
    "LastUpdateDate": "08/17/2025",
    "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": "171400000X",
          "TaxonomyName": "Health & Wellness Coach",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "171M00000X",
          "TaxonomyName": "Case Manager/Care Coordinator",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "175T00000X",
          "TaxonomyName": "Peer Specialist",
          "LicenseNumber": "1581-0322",
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "251S00000X",
          "TaxonomyName": "Community/Behavioral Health Agency",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "172V00000X",
          "TaxonomyName": "Community Health Worker",
          "LicenseNumber": "19037",
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

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