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1295506277 NPI number — GARCIA OUTLAW LCADC,CCS

NPI Number: 1295506277
Health Care Provider/Practitioner: GARCIA OUTLAW LCADC,CCS

Information about “1295506277” NPI (GARCIA OUTLAW LCADC,CCS) exists in 1295506277 in HTML format HTML  |  1295506277 in plain Text format TXT  |  1295506277 in PDF (Portable Document Format) PDF  |  1295506277 in an XML format XML  formats.

NPI Number : 1295506277 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1295506277",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "OUTLAW",
    "FirstName": "GARCIA",
    "MiddleName": null,
    "NamePrefix": "MR.",
    "NameSuffix": null,
    "Credential": "LCADC,CCS",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "850 WOODRUFF LANE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ELIZABETH",
    "MailingAddressStateName": "NJ",
    "MailingAddressPostalCode": "07201",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "908-352-0850",
    "MailingAddressFaxNumber": "908-352-1036",
    "FirstLinePracticeLocationAddress": "850 WOODRUFF LN",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ELIZABETH",
    "PracticeLocationAddressStateName": "NJ",
    "PracticeLocationAddressPostalCode": "07201-2022",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "908-352-0850",
    "PracticeLocationAddressFaxNumber": "908-352-1036",
    "EnumerationDate": "01/10/2024",
    "LastUpdateDate": "01/10/2024",
    "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": "101YA0400X",
        "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
        "LicenseNumber": "37LC00227700",
        "LicenseNumberStateCode": "NJ",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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