NPI Code Detail JSON Logo

1588042089 NPI number — KAILEY ROSE MAHAN LMHC

NPI Number: 1588042089
Health Care Provider/Practitioner: KAILEY ROSE MAHAN LMHC

Information about “1588042089” NPI (KAILEY ROSE MAHAN LMHC) exists in 1588042089 in HTML format HTML  |  1588042089 in plain Text format TXT  |  1588042089 in PDF (Portable Document Format) PDF  |  1588042089 in an XML format XML  formats.

NPI Number : 1588042089 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1588042089",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MAHAN",
    "FirstName": "KAILEY",
    "MiddleName": "ROSE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LMHC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "4440 OSCEOLA RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "TITUSVILLE",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "32780-6545",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "321-482-7429",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "5095 S WASHINGTON AVE STE 102",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "TITUSVILLE",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "32780-7333",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "407-917-6828",
    "PracticeLocationAddressFaxNumber": "321-888-4922",
    "EnumerationDate": "05/15/2015",
    "LastUpdateDate": "08/28/2019",
    "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": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": "MH16362",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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