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1114445103 NPI number — LESLIE WORTH LMFT

NPI Number: 1114445103
Health Care Provider/Practitioner: LESLIE WORTH LMFT

Information about “1114445103” NPI (LESLIE WORTH LMFT) exists in 1114445103 in HTML format HTML  |  1114445103 in plain Text format TXT  |  1114445103 in PDF (Portable Document Format) PDF  |  1114445103 in an XML format XML  formats.

NPI Number : 1114445103 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1114445103",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WORTH",
    "FirstName": "LESLIE",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LMFT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "MCKINLEY",
    "OtherFirstName": "LESLIE",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "PO BOX 1659",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "EUSTIS",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "32727-1659",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "352-217-4316",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "851 N DONNELLY ST STE 11",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MOUNT DORA",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "32757-4835",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "352-217-4316",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/30/2017",
    "LastUpdateDate": "09/06/2023",
    "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": "106H00000X",
        "TaxonomyName": "Marriage & Family Therapist",
        "LicenseNumber": "MT3834",
        "LicenseNumberStateCode": "FL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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