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1376872986 NPI number — KALOS COUNSELING AND DIAGNOSTICS, PLLC

NPI Number: 1376872986
Health Care Provider/Practitioner: KALOS COUNSELING AND DIAGNOSTICS, PLLC

Information about “1376872986” NPI (KALOS COUNSELING AND DIAGNOSTICS, PLLC) exists in 1376872986 in HTML format HTML  |  1376872986 in plain Text format TXT  |  1376872986 in PDF (Portable Document Format) PDF  |  1376872986 in an XML format XML  formats.

NPI Number : 1376872986 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1376872986",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "KALOS COUNSELING AND DIAGNOSTICS, PLLC",
    "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": "PO BOX 624",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "VIDOR",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "77670-0624",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "409-769-8910",
    "MailingAddressFaxNumber": "409-769-8914",
    "FirstLinePracticeLocationAddress": "1091 N MAIN ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "VIDOR",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "77662-4339",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "409-769-8910",
    "PracticeLocationAddressFaxNumber": "409-769-8914",
    "EnumerationDate": "12/09/2009",
    "LastUpdateDate": "12/09/2009",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "ODOM",
    "AuthorizedOfficialFirstName": "BENJAMIN",
    "AuthorizedOfficialMiddleName": "SCOTT",
    "AuthorizedOfficialTitle": "MANAGER",
    "AuthorizedOfficialNamePrefix": "MR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "M.ED., LPC",
    "AuthorizedOfficialTelephoneNumber": "409-769-8910",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "101YP2500X",
          "TaxonomyName": "Professional Counselor",
          "LicenseNumber": "62334",
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YP2500X",
          "TaxonomyName": "Professional Counselor",
          "LicenseNumber": "63792",
          "LicenseNumberStateCode": "TX",
          "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."
        },
        {
          "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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