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1174476311 NPI number — CLOUD BREAK PSYCHOTHERAPY LLC

NPI Number: 1174476311
Health Care Provider/Practitioner: CLOUD BREAK PSYCHOTHERAPY LLC

Information about “1174476311” NPI (CLOUD BREAK PSYCHOTHERAPY LLC) exists in 1174476311 in HTML format HTML  |  1174476311 in plain Text format TXT  |  1174476311 in PDF (Portable Document Format) PDF  |  1174476311 in an XML format XML  formats.

NPI Number : 1174476311 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1174476311",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "CLOUD BREAK PSYCHOTHERAPY LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "5500 NICOLLET AVE UNIT 19151",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MINNEAPOLIS",
    "MailingAddressStateName": "MN",
    "MailingAddressPostalCode": "55419-1982",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "218-839-4225",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4748 CHICAGO AVE STE 9",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MINNEAPOLIS",
    "PracticeLocationAddressStateName": "MN",
    "PracticeLocationAddressPostalCode": "55407-4320",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "218-839-4225",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "02/17/2026",
    "LastUpdateDate": "02/17/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "SUTEHALL",
    "AuthorizedOfficialFirstName": "JOCELYN",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "MARRIAGE & FAMILY THERAPIST",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "LMFT",
    "AuthorizedOfficialTelephoneNumber": "218-839-4225",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "106H00000X",
        "TaxonomyName": "Marriage & Family Therapist",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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