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1366594210 NPI number — BILL RAY LONG PHD

NPI Number: 1366594210
Health Care Provider/Practitioner: BILL RAY LONG PHD

Information about “1366594210” NPI (BILL RAY LONG PHD) exists in 1366594210 in HTML format HTML  |  1366594210 in plain Text format TXT  |  1366594210 in PDF (Portable Document Format) PDF  |  1366594210 in an XML format XML  formats.

NPI Number : 1366594210 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1366594210",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LONG",
    "FirstName": "BILL",
    "MiddleName": "RAY",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "PHD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "LONG",
    "OtherFirstName": "WILLIAM",
    "OtherMiddleName": "RAY",
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": null,
    "OtherCredential": "PHD",
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "531 N MAIN ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PUNXSUTAWNEY",
    "MailingAddressStateName": "PA",
    "MailingAddressPostalCode": "15767-2580",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "814-938-3977",
    "MailingAddressFaxNumber": "813-948-7339",
    "FirstLinePracticeLocationAddress": "531 N MAIN ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PUNXSUTAWNEY",
    "PracticeLocationAddressStateName": "PA",
    "PracticeLocationAddressPostalCode": "15767-2580",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "814-938-3977",
    "PracticeLocationAddressFaxNumber": "813-948-7339",
    "EnumerationDate": "01/18/2007",
    "LastUpdateDate": "07/08/2007",
    "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": "103TC0700X",
        "TaxonomyName": "Clinical Psychologist",
        "LicenseNumber": "PS-007666-L",
        "LicenseNumberStateCode": "PA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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