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1437703543 NPI number — JORDEN A KENREIGH-TOMAS MS, NCC, LAC

NPI Number: 1437703543
Health Care Provider/Practitioner: JORDEN A KENREIGH-TOMAS MS, NCC, LAC

Information about “1437703543” NPI (JORDEN A KENREIGH-TOMAS MS, NCC, LAC) exists in 1437703543 in HTML format HTML  |  1437703543 in plain Text format TXT  |  1437703543 in PDF (Portable Document Format) PDF  |  1437703543 in an XML format XML  formats.

NPI Number : 1437703543 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1437703543",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "KENREIGH-TOMAS",
    "FirstName": "JORDEN",
    "MiddleName": "A",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MS, NCC, LAC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "840 ILLINOIS AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BENTONVILLE",
    "MailingAddressStateName": "AR",
    "MailingAddressPostalCode": "72713-4081",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "360-448-0999",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "111 SE 22ND ST STE 11",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BENTONVILLE",
    "PracticeLocationAddressStateName": "AR",
    "PracticeLocationAddressPostalCode": "72712-5180",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "479-268-3280",
    "PracticeLocationAddressFaxNumber": "479-268-3305",
    "EnumerationDate": "07/26/2019",
    "LastUpdateDate": "11/07/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": "12/10/2021",
    "NPIReactivationDate": "01/12/2022",
    "GenderCode": "M",
    "Gender": "Male",
    "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": "A2411005",
        "LicenseNumberStateCode": "AR",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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