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1164699013 NPI number — AMANDA RENEE HART CC, LMT

NPI Number: 1164699013
Health Care Provider/Practitioner: AMANDA RENEE HART CC, LMT

Information about “1164699013” NPI (AMANDA RENEE HART CC, LMT) exists in 1164699013 in HTML format HTML  |  1164699013 in plain Text format TXT  |  1164699013 in PDF (Portable Document Format) PDF  |  1164699013 in an XML format XML  formats.

NPI Number : 1164699013 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1164699013",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "HART",
    "FirstName": "AMANDA",
    "MiddleName": "RENEE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "CC, LMT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "DOCKSTEADER",
    "OtherFirstName": "AMANDA",
    "OtherMiddleName": "RENEE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "LMT",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "1105 15TH AVE STE F",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LONGVIEW",
    "MailingAddressStateName": "WA",
    "MailingAddressPostalCode": "98632-3080",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "360-703-6499",
    "MailingAddressFaxNumber": "360-838-9902",
    "FirstLinePracticeLocationAddress": "1105 15TH AVE STE F",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LONGVIEW",
    "PracticeLocationAddressStateName": "WA",
    "PracticeLocationAddressPostalCode": "98632-3080",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "360-703-6499",
    "PracticeLocationAddressFaxNumber": "360-838-9902",
    "EnumerationDate": "05/09/2008",
    "LastUpdateDate": "05/09/2024",
    "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": "225700000X",
          "TaxonomyName": "Massage Therapist",
          "LicenseNumber": "MA00023855",
          "LicenseNumberStateCode": "WA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": "CL61519127",
          "LicenseNumberStateCode": "WA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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