1386898849 NPI number — SUSAN CAROL HENDERSON M.ED., LPC, LMFT

NPI Number: 1386898849
Health Care Provider/Practitioner: SUSAN CAROL HENDERSON M.ED., LPC, LMFT

NPI Number : 1386898849 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1386898849",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "HENDERSON",
    "FirstName": "SUSAN",
    "MiddleName": "CAROL",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "M.ED., LPC, LMFT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "550 S WATTERS RD STE 133",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ALLEN",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "75013-5225",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "972-654-8918",
    "MailingAddressFaxNumber": "214-856-5817",
    "FirstLinePracticeLocationAddress": "550 S WATTERS RD STE 133",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ALLEN",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "75013-5225",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "972-654-8918",
    "PracticeLocationAddressFaxNumber": "214-856-5817",
    "EnumerationDate": "11/11/2008",
    "LastUpdateDate": "07/13/2022",
    "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": "106H00000X",
          "TaxonomyName": "Marriage & Family Therapist",
          "LicenseNumber": "4351",
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YP2500X",
          "TaxonomyName": "Professional Counselor",
          "LicenseNumber": "11092",
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}