1104902519 NPI number — STEVEN L EARLL MA, MS, LFC, LAC

NPI Number: 1104902519
Health Care Provider/Practitioner: STEVEN L EARLL MA, MS, LFC, LAC

NPI Number : 1104902519 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1104902519",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "EARLL",
    "FirstName": "STEVEN",
    "MiddleName": "L",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MA, MS, LFC, LAC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "4291 AUSTIN BLUFFS PKWY",
    "SecondLineMailingAddress": "STE 102",
    "MailingAddressCityName": "COLORADO SPRINGS",
    "MailingAddressStateName": "CO",
    "MailingAddressPostalCode": "80918-2903",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "719-528-1929",
    "MailingAddressFaxNumber": "719-532-0897",
    "FirstLinePracticeLocationAddress": "4291 AUSTIN BLUFFS PKWY",
    "SecondLinePracticeLocationAddress": "STE 102",
    "PracticeLocationAddressCityName": "COLORADO SPRINGS",
    "PracticeLocationAddressStateName": "CO",
    "PracticeLocationAddressPostalCode": "80918-2903",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "719-528-1929",
    "PracticeLocationAddressFaxNumber": "719-532-0897",
    "EnumerationDate": "10/27/2006",
    "LastUpdateDate": "07/08/2007",
    "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": "103T00000X",
        "TaxonomyName": "Psychologist",
        "LicenseNumber": "2544",
        "LicenseNumberStateCode": "CO",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}