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1285246652 NPI number — WILL BRADON JOHN GROVE CMHC, LPC

NPI Number: 1285246652
Health Care Provider/Practitioner: WILL BRADON JOHN GROVE CMHC, LPC

Information about “1285246652” NPI (WILL BRADON JOHN GROVE CMHC, LPC) exists in 1285246652 in HTML format HTML  |  1285246652 in plain Text format TXT  |  1285246652 in PDF (Portable Document Format) PDF  |  1285246652 in an XML format XML  formats.

NPI Number : 1285246652 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1285246652",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GROVE",
    "FirstName": "WILL",
    "MiddleName": "BRADON JOHN",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "CMHC, LPC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "447 W BEARCAT DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SALT LAKE CITY",
    "MailingAddressStateName": "UT",
    "MailingAddressPostalCode": "84115-2519",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "801-355-2846",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "10434 S 1055 W STE 101",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SOUTH JORDAN",
    "PracticeLocationAddressStateName": "UT",
    "PracticeLocationAddressPostalCode": "84095-1521",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "801-355-2846",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/18/2020",
    "LastUpdateDate": "12/05/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "101Y00000X",
          "TaxonomyName": "Counselor",
          "LicenseNumber": "C8327",
          "LicenseNumberStateCode": "OR",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101Y00000X",
          "TaxonomyName": "Counselor",
          "LicenseNumber": "12307961-6004",
          "LicenseNumberStateCode": "UT",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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