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1215221957 NPI number — KENNETH TODD PEHRSON

NPI Number: 1215221957
Health Care Provider/Practitioner: KENNETH TODD PEHRSON

Information about “1215221957” NPI (KENNETH TODD PEHRSON) exists in 1215221957 in HTML format HTML  |  1215221957 in plain Text format TXT  |  1215221957 in PDF (Portable Document Format) PDF  |  1215221957 in an XML format XML  formats.

NPI Number : 1215221957 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1215221957",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PEHRSON",
    "FirstName": "KENNETH",
    "MiddleName": "TODD",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "PEHRSON",
    "OtherFirstName": "K. TODD",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "MSW",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "10228 ADOBE MOUNTAIN ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LAS VEGAS",
    "MailingAddressStateName": "NV",
    "MailingAddressPostalCode": "89178-6556",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "702-823-9042",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "10228 ADOBE MOUNTAIN ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LAS VEGAS",
    "PracticeLocationAddressStateName": "NV",
    "PracticeLocationAddressPostalCode": "89178-6556",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "702-823-9042",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/28/2011",
    "LastUpdateDate": "12/01/2021",
    "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": "251S00000X",
          "TaxonomyName": "Community/Behavioral Health Agency",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1041C0700X",
          "TaxonomyName": "Clinical Social Worker",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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