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1467104521 NPI number — DEDRA JOAN HARVELL MA, S/T

NPI Number: 1467104521
Health Care Provider/Practitioner: DEDRA JOAN HARVELL MA, S/T

Information about “1467104521” NPI (DEDRA JOAN HARVELL MA, S/T) exists in 1467104521 in HTML format HTML  |  1467104521 in plain Text format TXT  |  1467104521 in PDF (Portable Document Format) PDF  |  1467104521 in an XML format XML  formats.

NPI Number : 1467104521 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1467104521",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "HARVELL",
    "FirstName": "DEDRA",
    "MiddleName": "JOAN",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "MA, S/T",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 27653",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MACON",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "31221-7653",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "478-254-0481",
    "MailingAddressFaxNumber": "478-254-9723",
    "FirstLinePracticeLocationAddress": "611 N WAYNE ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MILLEDGEVILLE",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "31061-2834",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "478-254-0481",
    "PracticeLocationAddressFaxNumber": "478-254-9723",
    "EnumerationDate": "01/20/2022",
    "LastUpdateDate": "01/20/2022",
    "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": null,
        "LicenseNumberStateCode": "GA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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