NPI Code Detail JSON Logo

1457739567 NPI number — MICHELLE BOUTHILLIER LCSW, CGP

NPI Number: 1457739567
Health Care Provider/Practitioner: MICHELLE BOUTHILLIER LCSW, CGP

Information about “1457739567” NPI (MICHELLE BOUTHILLIER LCSW, CGP) exists in 1457739567 in HTML format HTML  |  1457739567 in plain Text format TXT  |  1457739567 in PDF (Portable Document Format) PDF  |  1457739567 in an XML format XML  formats.

NPI Number : 1457739567 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1457739567",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BOUTHILLIER",
    "FirstName": "MICHELLE",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LCSW, CGP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "10678 LAKE IAMONIA DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "TALLAHASSEE",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "32312-5102",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "850-597-5050",
    "MailingAddressFaxNumber": "850-668-4678",
    "FirstLinePracticeLocationAddress": "10678 LAKE IAMONIA DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "TALLAHASSEE",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "32312-5102",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "850-597-5050",
    "PracticeLocationAddressFaxNumber": "850-668-4678",
    "EnumerationDate": "05/08/2015",
    "LastUpdateDate": "05/08/2015",
    "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": "SW11731",
        "LicenseNumberStateCode": "FL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

Copyright © 2007-2026 Data Labs Health. All rights reserved.