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1316433097 NPI number — JESSE ALBERT/SHERMAN ALCORN M.S. PCLC, ACLC

NPI Number: 1316433097
Health Care Provider/Practitioner: JESSE ALBERT/SHERMAN ALCORN M.S. PCLC, ACLC

Information about “1316433097” NPI (JESSE ALBERT/SHERMAN ALCORN M.S. PCLC, ACLC) exists in 1316433097 in HTML format HTML  |  1316433097 in plain Text format TXT  |  1316433097 in PDF (Portable Document Format) PDF  |  1316433097 in an XML format XML  formats.

NPI Number : 1316433097 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1316433097",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ALCORN",
    "FirstName": "JESSE",
    "MiddleName": "ALBERT/SHERMAN",
    "NamePrefix": "MR.",
    "NameSuffix": null,
    "Credential": "M.S. PCLC, ACLC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1643 24TH ST W STE 210",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BILLINGS",
    "MailingAddressStateName": "MT",
    "MailingAddressPostalCode": "59102-2677",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "406-413-1205",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1643 24TH ST. W. SUITE 210",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BILLINGS",
    "PracticeLocationAddressStateName": "MT",
    "PracticeLocationAddressPostalCode": "59102",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "406-413-1205",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/06/2018",
    "LastUpdateDate": "05/31/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": "07/20/2022",
    "NPIReactivationDate": "05/25/2023",
    "GenderCode": "M",
    "Gender": "Male",
    "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": "BBH-PCLC-LIC-56949",
        "LicenseNumberStateCode": "MT",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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