1285876409 NPI number — MANUEL O. GOMEZ MS., LMH,MCAP, CCM,

NPI Number: 1285876409
Health Care Provider/Practitioner: MANUEL O. GOMEZ MS., LMH,MCAP, CCM,

NPI Number : 1285876409 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1285876409",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GOMEZ",
    "FirstName": "MANUEL",
    "MiddleName": "O.",
    "NamePrefix": "MR.",
    "NameSuffix": null,
    "Credential": "MS., LMH,MCAP, CCM,",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "141 E CENTRAL AVE STE 340",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WINTER HAVEN",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "33880-6339",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "863-412-8711",
    "MailingAddressFaxNumber": "877-340-0107",
    "FirstLinePracticeLocationAddress": "141 E CENTRAL AVE STE 340",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WINTER HAVEN",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33880",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "863-412-8711",
    "PracticeLocationAddressFaxNumber": "877-340-0107",
    "EnumerationDate": "04/02/2009",
    "LastUpdateDate": "09/27/2018",
    "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": "101YA0400X",
          "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
          "LicenseNumber": "ABC010814-215",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YP2500X",
          "TaxonomyName": "Professional Counselor",
          "LicenseNumber": "6158",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "171M00000X",
          "TaxonomyName": "Case Manager/Care Coordinator",
          "LicenseNumber": "131096",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "171M00000X",
          "TaxonomyName": "Case Manager/Care Coordinator",
          "LicenseNumber": "689259179",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": "11142",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}