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1386068476 NPI number — NAA Y ODEN BCBA, NCSP

NPI Number: 1386068476
Health Care Provider/Practitioner: NAA Y ODEN BCBA, NCSP

Information about “1386068476” NPI (NAA Y ODEN BCBA, NCSP) exists in 1386068476 in HTML format HTML  |  1386068476 in plain Text format TXT  |  1386068476 in PDF (Portable Document Format) PDF  |  1386068476 in an XML format XML  formats.

NPI Number : 1386068476 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1386068476",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ODEN",
    "FirstName": "NAA",
    "MiddleName": "Y",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "BCBA, NCSP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "ODEN",
    "OtherFirstName": "NAIA",
    "OtherMiddleName": "Y",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "4813 RIDGE RD STE 111-639",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DOUGLASVILLE",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "30134-6117",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "330-622-3766",
    "MailingAddressFaxNumber": "404-225-1840",
    "FirstLinePracticeLocationAddress": "4813 RIDGE RD STE 111-639",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DOUGLASVILLE",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "30134",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "330-622-3766",
    "PracticeLocationAddressFaxNumber": "404-225-1840",
    "EnumerationDate": "02/10/2014",
    "LastUpdateDate": "07/01/2019",
    "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": "103TS0200X",
          "TaxonomyName": "School Psychologist",
          "LicenseNumber": "OH3043645",
          "LicenseNumberStateCode": "OH",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "103K00000X",
          "TaxonomyName": "Behavior Analyst",
          "LicenseNumber": "1-19-35830",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X 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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