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1154684843 NPI number — SHELBY MARIE PELLETIER LCPC-C

NPI Number: 1154684843
Health Care Provider/Practitioner: SHELBY MARIE PELLETIER LCPC-C

Information about “1154684843” NPI (SHELBY MARIE PELLETIER LCPC-C) exists in 1154684843 in HTML format HTML  |  1154684843 in plain Text format TXT  |  1154684843 in PDF (Portable Document Format) PDF  |  1154684843 in an XML format XML  formats.

NPI Number : 1154684843 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1154684843",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PELLETIER",
    "FirstName": "SHELBY",
    "MiddleName": "MARIE",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "LCPC-C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "WILCOX",
    "OtherFirstName": "SHELBY",
    "OtherMiddleName": "MARIE",
    "OtherNamePrefix": "MS.",
    "OtherNameSuffix": null,
    "OtherCredential": "LCPC-C",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "180 MAIN ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WATERVILLE",
    "MailingAddressStateName": "ME",
    "MailingAddressPostalCode": "04901-6666",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "207-872-5300",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "180 MAIN ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WATERVILLE",
    "PracticeLocationAddressStateName": "ME",
    "PracticeLocationAddressPostalCode": "04901",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "207-872-5300",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/19/2012",
    "LastUpdateDate": "09/27/2013",
    "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": "101YP2500X",
        "TaxonomyName": "Professional Counselor",
        "LicenseNumber": "XL3707",
        "LicenseNumberStateCode": "ME",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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