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1245772896 NPI number — DESIREE N. WALISKY PH.D., LCSW

NPI Number: 1245772896
Health Care Provider/Practitioner: DESIREE N. WALISKY PH.D., LCSW

Information about “1245772896” NPI (DESIREE N. WALISKY PH.D., LCSW) exists in 1245772896 in HTML format HTML  |  1245772896 in plain Text format TXT  |  1245772896 in PDF (Portable Document Format) PDF  |  1245772896 in an XML format XML  formats.

NPI Number : 1245772896 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1245772896",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WALISKY",
    "FirstName": "DESIREE",
    "MiddleName": "N.",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PH.D., LCSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 5865",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LUBBOCK",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "79408-5865",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "806-743-2898",
    "MailingAddressFaxNumber": "806-743-2787",
    "FirstLinePracticeLocationAddress": "6610 QUAKER AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LUBBOCK",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "79413",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "806-743-4270",
    "PracticeLocationAddressFaxNumber": "806-743-9097",
    "EnumerationDate": "11/14/2016",
    "LastUpdateDate": "11/18/2021",
    "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": "1041C0700X",
        "TaxonomyName": "Clinical Social Worker",
        "LicenseNumber": "59000",
        "LicenseNumberStateCode": "TX",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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