1134446883 NPI number — JONATHAN CLARK MCCOWN L.C.S.W.

NPI Number: 1134446883
Health Care Provider/Practitioner: JONATHAN CLARK MCCOWN L.C.S.W.

NPI Number : 1134446883 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1134446883",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MCCOWN",
    "FirstName": "JONATHAN",
    "MiddleName": "CLARK",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "L.C.S.W.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "320 S GRAMERCY PL",
    "SecondLineMailingAddress": "106",
    "MailingAddressCityName": "LOS ANGELES",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "90020-4562",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "310-980-1365",
    "MailingAddressFaxNumber": "213-387-6134",
    "FirstLinePracticeLocationAddress": "9171 WILSHIRE BLVD",
    "SecondLinePracticeLocationAddress": "PH #2",
    "PracticeLocationAddressCityName": "BEVERLY HILLS",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "90210-5530",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "310-980-1365",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/20/2010",
    "LastUpdateDate": "04/20/2010",
    "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": "1041C0700X",
        "TaxonomyName": "Clinical Social Worker",
        "LicenseNumber": "LCS21517",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}