NPI Code Detail JSON Logo

1588085799 NPI number — MEDIATION & COUNSELING CENTER OF WESTERN KENTUCKY, INC.

NPI Number: 1588085799
Health Care Provider/Practitioner: MEDIATION & COUNSELING CENTER OF WESTERN KENTUCKY, INC.

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NPI Number : 1588085799 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1588085799",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "MEDIATION & COUNSELING CENTER OF WESTERN KENTUCKY, INC.",
    "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": "2400 FRIENDSHIP DR STE B",
    "SecondLineMailingAddress": "RONALD LOGSDON COMMUNITY CENTER AT PRESIDENTS PLACE",
    "MailingAddressCityName": "OWENSBORO",
    "MailingAddressStateName": "KY",
    "MailingAddressPostalCode": "42303-3011",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "270-852-6516",
    "MailingAddressFaxNumber": "270-683-9771",
    "FirstLinePracticeLocationAddress": "2400 FRIENDSHIP DR STE B",
    "SecondLinePracticeLocationAddress": "2400 FRIENDSHIP DRIVE, SUITE B",
    "PracticeLocationAddressCityName": "OWENSBORO",
    "PracticeLocationAddressStateName": "KY",
    "PracticeLocationAddressPostalCode": "42303-3011",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "270-852-6516",
    "PracticeLocationAddressFaxNumber": "270-683-9771",
    "EnumerationDate": "12/16/2013",
    "LastUpdateDate": "12/16/2013",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "BAIZE",
    "AuthorizedOfficialFirstName": "GREGORY",
    "AuthorizedOfficialMiddleName": "LEE",
    "AuthorizedOfficialTitle": "PRESIDENT/CEO",
    "AuthorizedOfficialNamePrefix": "MR.",
    "AuthorizedOfficialNameSuffix": "SR.",
    "AuthorizedOfficialCredential": "M.PSYCH., CCCT, CPC",
    "AuthorizedOfficialTelephoneNumber": "270-852-6516",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "251S00000X",
        "TaxonomyName": "Community/Behavioral Health Agency",
        "LicenseNumber": null,
        "LicenseNumberStateCode": "KY",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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