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1366218810 NPI number — NOURISH THERAPY, LLC

NPI Number: 1366218810
Health Care Provider/Practitioner: NOURISH THERAPY, LLC

Information about “1366218810” NPI (NOURISH THERAPY, LLC) exists in 1366218810 in HTML format HTML  |  1366218810 in plain Text format TXT  |  1366218810 in PDF (Portable Document Format) PDF  |  1366218810 in an XML format XML  formats.

NPI Number : 1366218810 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1366218810",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "NOURISH THERAPY, LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "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": "921 COLWICK DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DAYTON",
    "MailingAddressStateName": "OH",
    "MailingAddressPostalCode": "45420-1701",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "937-418-1453",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "921 COLWICK DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DAYTON",
    "PracticeLocationAddressStateName": "OH",
    "PracticeLocationAddressPostalCode": "45420-1701",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "937-418-1453",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/27/2023",
    "LastUpdateDate": "11/28/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "BASS",
    "AuthorizedOfficialFirstName": "WESLEY",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "OWNER/THERAPIST",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MA, LPCC-S",
    "AuthorizedOfficialTelephoneNumber": "937-418-1453",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261QM0801X",
        "TaxonomyName": "Mental Health Clinic/Center (Including Community Mental Health Center)",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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