1568684082 NPI number — SUELLEN M. DICKER MA, NCC, LCPC/ LPC

NPI Number: 1568684082
Health Care Provider/Practitioner: SUELLEN M. DICKER MA, NCC, LCPC/ LPC

NPI Number : 1568684082 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1568684082",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "DICKER",
    "FirstName": "SUELLEN",
    "MiddleName": "M.",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "MA, NCC, LCPC/ LPC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "831 W DELANO AVENUE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PRESCOTT",
    "MailingAddressStateName": "AZ",
    "MailingAddressPostalCode": "86301",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "217-841-8634",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "831 W. DELANO AVENUE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PRESCOTT",
    "PracticeLocationAddressStateName": "AZ",
    "PracticeLocationAddressPostalCode": "86301",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "217-841-8634",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/03/2007",
    "LastUpdateDate": "02/25/2014",
    "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": "180-004522",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YP2500X",
          "TaxonomyName": "Professional Counselor",
          "LicenseNumber": "LCPC-180-004522",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "101YP2500X",
          "TaxonomyName": "Professional Counselor",
          "LicenseNumber": "LPC-14534",
          "LicenseNumberStateCode": "AZ",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}