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1417186289 NPI number — KYSHEENNA SHERRELL MARSHALL LCSW

NPI Number: 1417186289
Health Care Provider/Practitioner: KYSHEENNA SHERRELL MARSHALL LCSW

Information about “1417186289” NPI (KYSHEENNA SHERRELL MARSHALL LCSW) exists in 1417186289 in HTML format HTML  |  1417186289 in plain Text format TXT  |  1417186289 in PDF (Portable Document Format) PDF  |  1417186289 in an XML format XML  formats.

NPI Number : 1417186289 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1417186289",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MARSHALL",
    "FirstName": "KYSHEENNA",
    "MiddleName": "SHERRELL",
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "LCSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "MARSHALL",
    "OtherFirstName": "KYSHEENNA",
    "OtherMiddleName": "SHERRELL",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "LCSW",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "609 WOODLAND MANOR DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CEDAR HILL",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "75104-6055",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "214-734-6579",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "609 WOODLAND MANOR DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CEDAR HILL",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "75104-6055",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "214-734-6579",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/14/2009",
    "LastUpdateDate": "02/05/2024",
    "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": "1041C0700X",
        "TaxonomyName": "Clinical Social Worker",
        "LicenseNumber": "53120",
        "LicenseNumberStateCode": "TX",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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