NPI Code Detail JSON Logo

1194177410 NPI number — CHRISTOPHER BOYDEN-DESHAZER LCSW

NPI Number: 1194177410
Health Care Provider/Practitioner: CHRISTOPHER BOYDEN-DESHAZER LCSW

Information about “1194177410” NPI (CHRISTOPHER BOYDEN-DESHAZER LCSW) exists in 1194177410 in HTML format HTML  |  1194177410 in plain Text format TXT  |  1194177410 in PDF (Portable Document Format) PDF  |  1194177410 in an XML format XML  formats.

NPI Number : 1194177410 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1194177410",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BOYDEN-DESHAZER",
    "FirstName": "CHRISTOPHER",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LCSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "521 W MONTANA ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PASADENA",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "91103-1329",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "626-733-2160",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "5901 W OLYMPIC BLVD STE 500",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LOS ANGELES",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "90036-4670",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "323-329-9380",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/11/2016",
    "LastUpdateDate": "11/20/2025",
    "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": "105913",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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