1356688790 NPI number — LISA TOBEY GROO LCPC, CADC, MHRT-CSP

NPI Number: 1356688790
Health Care Provider/Practitioner: LISA TOBEY GROO LCPC, CADC, MHRT-CSP

NPI Number : 1356688790 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1356688790",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GROO",
    "FirstName": "LISA",
    "MiddleName": "TOBEY",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LCPC, CADC, MHRT-CSP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "180 ACADEMY ST STE 3",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PRESQUE ISLE",
    "MailingAddressStateName": "ME",
    "MailingAddressPostalCode": "04769-3183",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "207-554-2352",
    "MailingAddressFaxNumber": "207-554-2351",
    "FirstLinePracticeLocationAddress": "406 STATE ST STE 2",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ELLSWORTH",
    "PracticeLocationAddressStateName": "ME",
    "PracticeLocationAddressPostalCode": "04605-3331",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "207-412-0973",
    "PracticeLocationAddressFaxNumber": "207-412-0806",
    "EnumerationDate": "01/04/2013",
    "LastUpdateDate": "02/02/2021",
    "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": "101Y00000X",
          "TaxonomyName": "Counselor",
          "LicenseNumber": "CAC6747",
          "LicenseNumberStateCode": "ME",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101Y00000X",
          "TaxonomyName": "Counselor",
          "LicenseNumber": "CC4620",
          "LicenseNumberStateCode": "ME",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}