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1487351656 NPI number — STACY TELLO

NPI Number: 1487351656
Health Care Provider/Practitioner: STACY TELLO

Information about “1487351656” NPI (STACY TELLO) exists in 1487351656 in HTML format HTML  |  1487351656 in plain Text format TXT  |  1487351656 in PDF (Portable Document Format) PDF  |  1487351656 in an XML format XML  formats.

NPI Number : 1487351656 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1487351656",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "TELLO",
    "FirstName": "STACY",
    "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": "PO BOX 748465",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ATLANTA",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "30374-8465",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "855-284-7483",
    "MailingAddressFaxNumber": "617-807-0958",
    "FirstLinePracticeLocationAddress": "9300 RESEARCH BLVD STE 320",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "AUSTIN",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "78759-6569",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "855-284-7483",
    "PracticeLocationAddressFaxNumber": "617-807-0958",
    "EnumerationDate": "02/08/2023",
    "LastUpdateDate": "02/08/2023",
    "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": "101YP2500X",
        "TaxonomyName": "Professional Counselor",
        "LicenseNumber": "88416",
        "LicenseNumberStateCode": "TX",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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