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1619629995 NPI number — CANDICE M SCOVILLE LPC, SAC-IT

NPI Number: 1619629995
Health Care Provider/Practitioner: CANDICE M SCOVILLE LPC, SAC-IT

Information about “1619629995” NPI (CANDICE M SCOVILLE LPC, SAC-IT) exists in 1619629995 in HTML format HTML  |  1619629995 in plain Text format TXT  |  1619629995 in PDF (Portable Document Format) PDF  |  1619629995 in an XML format XML  formats.

NPI Number : 1619629995 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1619629995",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SCOVILLE",
    "FirstName": "CANDICE",
    "MiddleName": "M",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LPC, SAC-IT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "ZEHNER",
    "OtherFirstName": "CANDICE",
    "OtherMiddleName": "M",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "LPC, SAC-IT",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "514 RIVERVIEW AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WAUKESHA",
    "MailingAddressStateName": "WI",
    "MailingAddressPostalCode": "53188-3631",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "262-896-8051",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "514 RIVERVIEW AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WAUKESHA",
    "PracticeLocationAddressStateName": "WI",
    "PracticeLocationAddressPostalCode": "53188-3631",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "262-548-7666",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/19/2022",
    "LastUpdateDate": "02/12/2025",
    "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": "101YA0400X",
          "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
          "LicenseNumber": "20171-130",
          "LicenseNumberStateCode": "WI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": "10560-125",
          "LicenseNumberStateCode": "WI",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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