1285029629 NPI number — KATHLEEN SUSAN WENGER M.A, LMFT, LPCC

NPI Number: 1285029629
Health Care Provider/Practitioner: KATHLEEN SUSAN WENGER M.A, LMFT, LPCC

NPI Number : 1285029629 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1285029629",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WENGER",
    "FirstName": "KATHLEEN",
    "MiddleName": "SUSAN",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "M.A, LMFT, LPCC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "PRESTON",
    "OtherFirstName": "KATHLEEN",
    "OtherMiddleName": "SUSAN",
    "OtherNamePrefix": "MS.",
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "1550 SOUTH PACIFIC COAST HIGHWAY",
    "SecondLineMailingAddress": "#205",
    "MailingAddressCityName": "LAGUNA BEACH",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "92651",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "949-357-3587",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1550 SOUTH PACIFIC COAST HIGHWAY",
    "SecondLinePracticeLocationAddress": "#205",
    "PracticeLocationAddressCityName": "LAGUNA BEACH",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92651",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "949-357-3587",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/02/2015",
    "LastUpdateDate": "04/02/2015",
    "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": "1450",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "106H00000X",
          "TaxonomyName": "Marriage & Family Therapist",
          "LicenseNumber": "38183",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}