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1568999050 NPI number — PHILLIP S KECK, PHD, LLC

NPI Number: 1568999050
Health Care Provider/Practitioner: PHILLIP S KECK, PHD, LLC

Information about “1568999050” NPI (PHILLIP S KECK, PHD, LLC) exists in 1568999050 in HTML format HTML  |  1568999050 in plain Text format TXT  |  1568999050 in PDF (Portable Document Format) PDF  |  1568999050 in an XML format XML  formats.

NPI Number : 1568999050 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1568999050",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "PHILLIP S KECK, PHD, LLC",
    "LastName": null,
    "FirstName": null,
    "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 13650",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "RICHMOND",
    "MailingAddressStateName": "VA",
    "MailingAddressPostalCode": "23225-8650",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "804-640-6848",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "681 HIOAKS RD STE E",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "RICHMOND",
    "PracticeLocationAddressStateName": "VA",
    "PracticeLocationAddressPostalCode": "23225-4043",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "804-420-9189",
    "PracticeLocationAddressFaxNumber": "844-308-5846",
    "EnumerationDate": "05/16/2017",
    "LastUpdateDate": "07/21/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "KECK",
    "AuthorizedOfficialFirstName": "PHILLIP",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "DIRECTOR AND CEO",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "PHD",
    "AuthorizedOfficialTelephoneNumber": "804-640-6848",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "103TC0700X",
        "TaxonomyName": "Clinical Psychologist",
        "LicenseNumber": "0810005353",
        "LicenseNumberStateCode": "VA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

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