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1467190777 NPI number — THOMAS MICHAEL RUSSELL JR. BA

NPI Number: 1467190777
Health Care Provider/Practitioner: THOMAS MICHAEL RUSSELL JR. BA

Information about “1467190777” NPI (THOMAS MICHAEL RUSSELL JR. BA) exists in 1467190777 in HTML format HTML  |  1467190777 in plain Text format TXT  |  1467190777 in PDF (Portable Document Format) PDF  |  1467190777 in an XML format XML  formats.

NPI Number : 1467190777 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1467190777",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "RUSSELL",
    "FirstName": "THOMAS",
    "MiddleName": "MICHAEL",
    "NamePrefix": "MR.",
    "NameSuffix": "JR.",
    "Credential": "BA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "RUSSELL",
    "OtherFirstName": "THOMAS",
    "OtherMiddleName": "MICHAEL",
    "OtherNamePrefix": "MR.",
    "OtherNameSuffix": "JR.",
    "OtherCredential": "BA",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "211 WESTBROOK RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ALVATON",
    "MailingAddressStateName": "KY",
    "MailingAddressPostalCode": "42122-8682",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "502-553-5746",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "5966 SCOTTSVILLE RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BOWLING GREEN",
    "PracticeLocationAddressStateName": "KY",
    "PracticeLocationAddressPostalCode": "42104-0387",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "270-904-5104",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/25/2022",
    "LastUpdateDate": "05/25/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "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": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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