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1386930733 NPI number — THAD SHANE DICKSON CPHIMS, PMP

NPI Number: 1386930733
Health Care Provider/Practitioner: THAD SHANE DICKSON CPHIMS, PMP

Information about “1386930733” NPI (THAD SHANE DICKSON CPHIMS, PMP) exists in 1386930733 in HTML format HTML  |  1386930733 in plain Text format TXT  |  1386930733 in PDF (Portable Document Format) PDF  |  1386930733 in an XML format XML  formats.

NPI Number : 1386930733 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1386930733",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "DICKSON",
    "FirstName": "THAD",
    "MiddleName": "SHANE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "CPHIMS, PMP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "16511 34TH STREET KP N",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LAKEBAY",
    "MailingAddressStateName": "WA",
    "MailingAddressPostalCode": "98349-9774",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "253-651-7482",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "16511 34TH STREET KP N",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LAKEBAY",
    "PracticeLocationAddressStateName": "WA",
    "PracticeLocationAddressPostalCode": "98349-9774",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "253-651-7482",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/23/2011",
    "LastUpdateDate": "05/07/2014",
    "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": "246Z00000X",
          "TaxonomyName": "Other Specialist/Technologist",
          "LicenseNumber": "CPHIMS - 1592",
          "LicenseNumberStateCode": "WA",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": null,
          "LicenseNumberStateCode": "WA",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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