1265818769 NPI number — CYNTHIA LEE CHAUSSE ED.D., L.M.H.C LPC

NPI Number: 1265818769
Health Care Provider/Practitioner: CYNTHIA LEE CHAUSSE ED.D., L.M.H.C LPC

NPI Number : 1265818769 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1265818769",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "CHAUSSE",
    "FirstName": "CYNTHIA",
    "MiddleName": "LEE",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "ED.D., L.M.H.C LPC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "NIST",
    "OtherFirstName": "CYNTHIA",
    "OtherMiddleName": "LEE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "L.M.H.C.",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "22 GILMER LN",
    "SecondLineMailingAddress": "SOUL CARE SOLUTION",
    "MailingAddressCityName": "GALAX",
    "MailingAddressStateName": "VA",
    "MailingAddressPostalCode": "24333-5173",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "941-815-0950",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "106 N MAIN ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "GALAX",
    "PracticeLocationAddressStateName": "VA",
    "PracticeLocationAddressPostalCode": "24333-2978",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "941-815-0950",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/06/2015",
    "LastUpdateDate": "02/22/2022",
    "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": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": "070100785",
          "LicenseNumberStateCode": "VA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YP2500X",
          "TaxonomyName": "Professional Counselor",
          "LicenseNumber": "070100785",
          "LicenseNumberStateCode": "VA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YP2500X",
          "TaxonomyName": "Professional Counselor",
          "LicenseNumber": "MH3566",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YS0200X",
          "TaxonomyName": "School Counselor",
          "LicenseNumber": null,
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": "MH3566",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}