NPI Code Detail JSON Logo

1194018424 NPI number — OPTIMUM MENTAL HEALTH SERVICES, LLC

NPI Number: 1194018424
Health Care Provider/Practitioner: OPTIMUM MENTAL HEALTH SERVICES, LLC

Information about “1194018424” NPI (OPTIMUM MENTAL HEALTH SERVICES, LLC) exists in 1194018424 in HTML format HTML  |  1194018424 in plain Text format TXT  |  1194018424 in PDF (Portable Document Format) PDF  |  1194018424 in an XML format XML  formats.

NPI Number : 1194018424 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1194018424",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "OPTIMUM MENTAL HEALTH SERVICES, 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": "559 HIAWATHA PALM PL",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "APOPKA",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "32712-3315",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "407-703-3569",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "559 HIAWATHA PALM PL",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "APOPKA",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "32712-3315",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "407-703-3569",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/19/2011",
    "LastUpdateDate": "01/03/2013",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "PHILLIPS",
    "AuthorizedOfficialFirstName": "LASCELLS",
    "AuthorizedOfficialMiddleName": "MARTIN",
    "AuthorizedOfficialTitle": "CEO",
    "AuthorizedOfficialNamePrefix": "MR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "LCSW",
    "AuthorizedOfficialTelephoneNumber": "407-703-3569",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "1041C0700X",
        "TaxonomyName": "Clinical Social Worker",
        "LicenseNumber": "SW8417",
        "LicenseNumberStateCode": "FL",
        "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."
      }
    }
  }
}
                
            

Copyright © 2007-2026 Data Labs Health. All rights reserved.