1235323015 NPI number — CHRISTI FULWOOD L.P.C., N.C.C.

NPI Number: 1235323015
Health Care Provider/Practitioner: CHRISTI FULWOOD L.P.C., N.C.C.

NPI Number : 1235323015 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1235323015",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "FULWOOD",
    "FirstName": "CHRISTI",
    "MiddleName": null,
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "L.P.C., N.C.C.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "BRANDENSTEIN",
    "OtherFirstName": "CHRISTI",
    "OtherMiddleName": null,
    "OtherNamePrefix": "MRS.",
    "OtherNameSuffix": null,
    "OtherCredential": "LPC, NCC",
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "2625 S KINGSHIGHWAY BLVD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SAINT LOUIS",
    "MailingAddressStateName": "MO",
    "MailingAddressPostalCode": "63139-1003",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "314-776-1228",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "3309 S KINGSHIGHWAY BLVD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SAINT LOUIS",
    "PracticeLocationAddressStateName": "MO",
    "PracticeLocationAddressPostalCode": "63139-1101",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "314-534-9350",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/05/2007",
    "LastUpdateDate": "09/05/2007",
    "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": "2007008630",
          "LicenseNumberStateCode": "MO",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "101YP2500X",
          "TaxonomyName": "Professional Counselor",
          "LicenseNumber": "1600",
          "LicenseNumberStateCode": "TN",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}