1568691574 NPI number — FRED HENRY PAULI L.M.H.C., L.P.C.

NPI Number: 1568691574
Health Care Provider/Practitioner: FRED HENRY PAULI L.M.H.C., L.P.C.

NPI Number : 1568691574 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1568691574",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PAULI",
    "FirstName": "FRED",
    "MiddleName": "HENRY",
    "NamePrefix": "MR.",
    "NameSuffix": null,
    "Credential": "L.M.H.C., L.P.C.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 51153",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "JACKSONVILLE BEACH",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "32240-1153",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "904-246-2457",
    "MailingAddressFaxNumber": "904-246-2152",
    "FirstLinePracticeLocationAddress": "422 5TH AVE N",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "JACKSONVILLE BEACH",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "32250-5614",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "904-246-2457",
    "PracticeLocationAddressFaxNumber": "904-246-2152",
    "EnumerationDate": "07/11/2009",
    "LastUpdateDate": "07/11/2009",
    "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": "LPC001249",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YA0400X",
          "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
          "LicenseNumber": "MH 6641",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YA0400X",
          "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
          "LicenseNumber": "LPC001249",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": "MH 6641",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "101YP2500X",
          "TaxonomyName": "Professional Counselor",
          "LicenseNumber": "LPC001249",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}