1417211269 NPI number — SRLESTINE T DAVIS M.ED.,LPC,CSC,CI

NPI Number: 1417211269
Health Care Provider/Practitioner: SRLESTINE T DAVIS M.ED.,LPC,CSC,CI

NPI Number : 1417211269 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1417211269",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "DAVIS",
    "FirstName": "SRLESTINE",
    "MiddleName": "T",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "M.ED.,LPC,CSC,CI",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "DAVIS",
    "OtherFirstName": "LESTINE",
    "OtherMiddleName": "T",
    "OtherNamePrefix": "MRS.",
    "OtherNameSuffix": null,
    "OtherCredential": "M.ED.,LPC,CSC,LCDC",
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "12401 S POST OAK RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "HOUSTON",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "77045-2020",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "713-551-8655",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "12401 S POST OAK RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "HOUSTON",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "77045-2020",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "713-551-8655",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/26/2012",
    "LastUpdateDate": "12/09/2014",
    "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": "101Y00000X",
          "TaxonomyName": "Counselor",
          "LicenseNumber": "GRADES EC-12",
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YA0400X",
          "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
          "LicenseNumber": "6979",
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YP2500X",
          "TaxonomyName": "Professional Counselor",
          "LicenseNumber": "65349",
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}