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1376141937 NPI number — TREE OF LIFE PSYCHOTHERAPY, LLC

NPI Number: 1376141937
Health Care Provider/Practitioner: TREE OF LIFE PSYCHOTHERAPY, LLC

Information about “1376141937” NPI (TREE OF LIFE PSYCHOTHERAPY, LLC) exists in 1376141937 in HTML format HTML  |  1376141937 in plain Text format TXT  |  1376141937 in PDF (Portable Document Format) PDF  |  1376141937 in an XML format XML  formats.

NPI Number : 1376141937 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1376141937",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "TREE OF LIFE PSYCHOTHERAPY, 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": "3540 WHEELER RD STE 619",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "AUGUSTA",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "30909-6534",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "706-395-8606",
    "MailingAddressFaxNumber": "706-395-8610",
    "FirstLinePracticeLocationAddress": "3540 WHEELER RD STE 619",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "AUGUSTA",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "30909-6534",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "706-395-8606",
    "PracticeLocationAddressFaxNumber": "706-395-8610",
    "EnumerationDate": "10/15/2020",
    "LastUpdateDate": "08/11/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "ALVAREZ",
    "AuthorizedOfficialFirstName": "JENNIFER",
    "AuthorizedOfficialMiddleName": "LICHTENBERG",
    "AuthorizedOfficialTitle": "OWNER",
    "AuthorizedOfficialNamePrefix": "MRS.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "LMFT",
    "AuthorizedOfficialTelephoneNumber": "706-831-9440",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "106H00000X",
        "TaxonomyName": "Marriage & Family Therapist",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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