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1558750612 NPI number — JOHN PETER MCCREADY SUDCC-IV-CS

NPI Number: 1558750612
Health Care Provider/Practitioner: JOHN PETER MCCREADY SUDCC-IV-CS

Information about “1558750612” NPI (JOHN PETER MCCREADY SUDCC-IV-CS) exists in 1558750612 in HTML format HTML  |  1558750612 in plain Text format TXT  |  1558750612 in PDF (Portable Document Format) PDF  |  1558750612 in an XML format XML  formats.

NPI Number : 1558750612 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1558750612",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MCCREADY",
    "FirstName": "JOHN",
    "MiddleName": "PETER",
    "NamePrefix": "MR.",
    "NameSuffix": null,
    "Credential": "SUDCC-IV-CS",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "GENERAL DELIVERY",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WALNUT CREEK",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "94596-9999",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "GENERAL DELIVERY",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WALNUT CREEK",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "94596-9999",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "760-429-0747",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/13/2015",
    "LastUpdateDate": "10/29/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": "02/27/2023",
    "NPIReactivationDate": "10/28/2025",
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "101YA0400X",
        "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
        "LicenseNumber": "CADTP-6142",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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