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1558684274 NPI number — JACK WORTH KILCREASE II LPC

NPI Number: 1558684274
Health Care Provider/Practitioner: JACK WORTH KILCREASE II LPC

Information about “1558684274” NPI (JACK WORTH KILCREASE II LPC) exists in 1558684274 in HTML format HTML  |  1558684274 in plain Text format TXT  |  1558684274 in PDF (Portable Document Format) PDF  |  1558684274 in an XML format XML  formats.

NPI Number : 1558684274 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1558684274",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "KILCREASE",
    "FirstName": "JACK",
    "MiddleName": "WORTH",
    "NamePrefix": "MR.",
    "NameSuffix": "II",
    "Credential": "LPC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "KILCREASE",
    "OtherFirstName": "J. WORTH",
    "OtherMiddleName": null,
    "OtherNamePrefix": "MR.",
    "OtherNameSuffix": null,
    "OtherCredential": "LPC",
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "4833 SPICEWOOD SPRINGS RD",
    "SecondLineMailingAddress": "SUITE 101",
    "MailingAddressCityName": "AUSTIN",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "78759-7253",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "512-658-2674",
    "MailingAddressFaxNumber": "512-346-0082",
    "FirstLinePracticeLocationAddress": "4833 SPICEWOOD SPRINGS RD",
    "SecondLinePracticeLocationAddress": "SUITE 101",
    "PracticeLocationAddressCityName": "AUSTIN",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "78759-7253",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "512-658-2674",
    "PracticeLocationAddressFaxNumber": "512-346-0082",
    "EnumerationDate": "03/09/2010",
    "LastUpdateDate": "03/09/2010",
    "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": "101Y00000X",
        "TaxonomyName": "Counselor",
        "LicenseNumber": "59946",
        "LicenseNumberStateCode": "TX",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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