NPI Code Detail JSON Logo

1306669452 NPI number — CHARISSA QWINDELL REID

NPI Number: 1306669452
Health Care Provider/Practitioner: CHARISSA QWINDELL REID

Information about “1306669452” NPI (CHARISSA QWINDELL REID) exists in 1306669452 in HTML format HTML  |  1306669452 in plain Text format TXT  |  1306669452 in PDF (Portable Document Format) PDF  |  1306669452 in an XML format XML  formats.

NPI Number : 1306669452 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1306669452",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "REID",
    "FirstName": "CHARISSA",
    "MiddleName": "QWINDELL",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "4850 ARID AVE APT 2074",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LAS VEGAS",
    "MailingAddressStateName": "NV",
    "MailingAddressPostalCode": "89115-0793",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "702-945-8393",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2820 W CHARLESTON BLVD STE 23",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LAS VEGAS",
    "PracticeLocationAddressStateName": "NV",
    "PracticeLocationAddressPostalCode": "89102-1933",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "702-602-5103",
    "PracticeLocationAddressFaxNumber": "725-302-2406",
    "EnumerationDate": "11/06/2024",
    "LastUpdateDate": "11/06/2024",
    "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": "106S00000X",
        "TaxonomyName": "Behavior Technician",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

Copyright © 2007-2026 Data Labs Health. All rights reserved.