NPI Code Detail JSON Logo

1235999293 NPI number — DEBORAH FAYE WALLACE LCPC LICENSED CLINIC

NPI Number: 1235999293
Health Care Provider/Practitioner: DEBORAH FAYE WALLACE LCPC LICENSED CLINIC

Information about “1235999293” NPI (DEBORAH FAYE WALLACE LCPC LICENSED CLINIC) exists in 1235999293 in HTML format HTML  |  1235999293 in plain Text format TXT  |  1235999293 in PDF (Portable Document Format) PDF  |  1235999293 in an XML format XML  formats.

NPI Number : 1235999293 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1235999293",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WALLACE",
    "FirstName": "DEBORAH",
    "MiddleName": "FAYE",
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "LCPC LICENSED CLINIC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "WALLACE",
    "OtherFirstName": "DEBORAH",
    "OtherMiddleName": "FAYE",
    "OtherNamePrefix": "MS.",
    "OtherNameSuffix": null,
    "OtherCredential": "LCPC MENTAL HEALTH T",
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "17232 PARKSIDE DRIVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CARLINVILLE",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "62626",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "217-827-0523",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "18772 RT. 4",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CARLINVILLE",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "62626",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "217-854-2712",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/19/2024",
    "LastUpdateDate": "03/19/2024",
    "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": "180.003816",
        "LicenseNumberStateCode": "IL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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