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1477687416 NPI number — SHANNA DENISE NELSON LCSW

NPI Number: 1477687416
Health Care Provider/Practitioner: SHANNA DENISE NELSON LCSW

Information about “1477687416” NPI (SHANNA DENISE NELSON LCSW) exists in 1477687416 in HTML format HTML  |  1477687416 in plain Text format TXT  |  1477687416 in PDF (Portable Document Format) PDF  |  1477687416 in an XML format XML  formats.

NPI Number : 1477687416 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1477687416",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "NELSON",
    "FirstName": "SHANNA",
    "MiddleName": "DENISE",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "LCSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "WILLIAMS",
    "OtherFirstName": "SHANNA",
    "OtherMiddleName": "DENISE",
    "OtherNamePrefix": "MISS",
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "4011 HEPBURN AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LOS ANGELES",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "90008-2736",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "323-296-0124",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "5901 E 7TH ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LONG BEACH",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "90822-5201",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "562-826-8000",
    "PracticeLocationAddressFaxNumber": "562-826-5471",
    "EnumerationDate": "03/14/2007",
    "LastUpdateDate": "12/01/2021",
    "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": "16583",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1041C0700X",
          "TaxonomyName": "Clinical Social Worker",
          "LicenseNumber": "25158",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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