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1417495474 NPI number — MENTAL HEALTH & SPIRITUAL WELLNESS THERAPEUTIC SERVICES

NPI Number: 1417495474
Health Care Provider/Practitioner: MENTAL HEALTH & SPIRITUAL WELLNESS THERAPEUTIC SERVICES

Information about “1417495474” NPI (MENTAL HEALTH & SPIRITUAL WELLNESS THERAPEUTIC SERVICES) exists in 1417495474 in HTML format HTML  |  1417495474 in plain Text format TXT  |  1417495474 in PDF (Portable Document Format) PDF  |  1417495474 in an XML format XML  formats.

NPI Number : 1417495474 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1417495474",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "MENTAL HEALTH & SPIRITUAL WELLNESS THERAPEUTIC SERVICES",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "213-D SOUTH TRADE STREET",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SHELBY",
    "MailingAddressStateName": "NC",
    "MailingAddressPostalCode": "28150-4564",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "704-231-9025",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "213-D S TRADE STREET",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SHELBY",
    "PracticeLocationAddressStateName": "NC",
    "PracticeLocationAddressPostalCode": "28150-4866",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "704-231-9025",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "02/09/2017",
    "LastUpdateDate": "02/09/2017",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "LYNCH",
    "AuthorizedOfficialFirstName": "TYNECCA",
    "AuthorizedOfficialMiddleName": "GAIL",
    "AuthorizedOfficialTitle": "OWNER/ PSYCHOTHERAPIST",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "PHD, LCSW",
    "AuthorizedOfficialTelephoneNumber": "704-231-9025",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "1041C0700X",
        "TaxonomyName": "Clinical Social Worker",
        "LicenseNumber": "C006811",
        "LicenseNumberStateCode": "NC",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

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