NPI Code Detail JSON Logo

1467149856 NPI number — LIGHT SPACE MENTAL HEALTH COUNSELING AND NURSE PRACTITIONER IN PSYCHIATRY PLLC

NPI Number: 1467149856
Health Care Provider/Practitioner: LIGHT SPACE MENTAL HEALTH COUNSELING AND NURSE PRACTITIONER IN PSYCHIATRY PLLC

Information about “1467149856” NPI (LIGHT SPACE MENTAL HEALTH COUNSELING AND NURSE PRACTITIONER IN PSYCHIATRY PLLC) exists in 1467149856 in HTML format HTML  |  1467149856 in plain Text format TXT  |  1467149856 in PDF (Portable Document Format) PDF  |  1467149856 in an XML format XML  formats.

NPI Number : 1467149856 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1467149856",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "LIGHT SPACE MENTAL HEALTH COUNSELING AND NURSE PRACTITIONER IN PSYCHIATRY PLLC",
    "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": "418 BROADWAY STE 4279",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ALBANY",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "12207-2922",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "937-756-6697",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "418 BROADWAY STE 4279",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ALBANY",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "12207-2922",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "937-756-6697",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/18/2023",
    "LastUpdateDate": "08/15/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "BUKAI",
    "AuthorizedOfficialFirstName": "JOEY",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "OWNER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "PMHNP-BC, LMHC, RN",
    "AuthorizedOfficialTelephoneNumber": "937-756-6697",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363LP0808X",
        "TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "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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