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1427758325 NPI number — TRACY LOUISE WILSON LCPCC

NPI Number: 1427758325
Health Care Provider/Practitioner: TRACY LOUISE WILSON LCPCC

Information about “1427758325” NPI (TRACY LOUISE WILSON LCPCC) exists in 1427758325 in HTML format HTML  |  1427758325 in plain Text format TXT  |  1427758325 in PDF (Portable Document Format) PDF  |  1427758325 in an XML format XML  formats.

NPI Number : 1427758325 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1427758325",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WILSON",
    "FirstName": "TRACY",
    "MiddleName": "LOUISE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LCPCC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "WILSON",
    "OtherFirstName": "TRACY",
    "OtherMiddleName": "L",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "LCPCC",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "PO BOX 17491",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MISSOULA",
    "MailingAddressStateName": "MT",
    "MailingAddressPostalCode": "59808-7491",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "406-531-1042",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "300 W BROADWAY ST STE 2",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MISSOULA",
    "PracticeLocationAddressStateName": "MT",
    "PracticeLocationAddressPostalCode": "59802-4126",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "406-531-1042",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/08/2023",
    "LastUpdateDate": "03/24/2023",
    "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": "101YM0800X",
        "TaxonomyName": "Mental Health Counselor",
        "LicenseNumber": "62548",
        "LicenseNumberStateCode": "MT",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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