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1629117981 NPI number — EMILY JEAN MADDOX LPCC #374

NPI Number: 1629117981
Health Care Provider/Practitioner: EMILY JEAN MADDOX LPCC #374

Information about “1629117981” NPI (EMILY JEAN MADDOX LPCC #374) exists in 1629117981 in HTML format HTML  |  1629117981 in plain Text format TXT  |  1629117981 in PDF (Portable Document Format) PDF  |  1629117981 in an XML format XML  formats.

NPI Number : 1629117981 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1629117981",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MADDOX",
    "FirstName": "EMILY",
    "MiddleName": "JEAN",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "LPCC #374",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "NELSON",
    "OtherFirstName": "EMILY",
    "OtherMiddleName": "JEAN",
    "OtherNamePrefix": "MISS",
    "OtherNameSuffix": null,
    "OtherCredential": "LPCC",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "1359 SCOTT LEE DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "OCEANO",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "93445-9155",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "559-362-0676",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "107 NELSON ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ARROYO GRANDE",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "93420-3318",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "805-362-0676",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "02/05/2007",
    "LastUpdateDate": "10/23/2018",
    "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": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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