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1194929562 NPI number — DEBRA KAY ELLIS LPC, LBSW,ACBSW

NPI Number: 1194929562
Health Care Provider/Practitioner: DEBRA KAY ELLIS LPC, LBSW,ACBSW

Information about “1194929562” NPI (DEBRA KAY ELLIS LPC, LBSW,ACBSW) exists in 1194929562 in HTML format HTML  |  1194929562 in plain Text format TXT  |  1194929562 in PDF (Portable Document Format) PDF  |  1194929562 in an XML format XML  formats.

NPI Number : 1194929562 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1194929562",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ELLIS",
    "FirstName": "DEBRA",
    "MiddleName": "KAY",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LPC, LBSW,ACBSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "4388 W VICKERY BLVD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FT WORTH",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "76107-6339",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "817-996-7548",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4388 W VICKERY BLVD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FT WORTH",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "76107-6339",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "817-996-7548",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/12/2007",
    "LastUpdateDate": "06/26/2015",
    "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": "63387",
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "1041S0200X",
          "TaxonomyName": "School Social Worker",
          "LicenseNumber": "015218",
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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