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1629646609 NPI number — MARY CLARE CROCKER LPC

NPI Number: 1629646609
Health Care Provider/Practitioner: MARY CLARE CROCKER LPC

Information about “1629646609” NPI (MARY CLARE CROCKER LPC) exists in 1629646609 in HTML format HTML  |  1629646609 in plain Text format TXT  |  1629646609 in PDF (Portable Document Format) PDF  |  1629646609 in an XML format XML  formats.

NPI Number : 1629646609 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1629646609",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "CROCKER",
    "FirstName": "MARY",
    "MiddleName": "CLARE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LPC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1911 W CHAFFEE PL",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DENVER",
    "MailingAddressStateName": "CO",
    "MailingAddressPostalCode": "80211-1542",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "469-560-2330",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "5277 MANHATTAN CIR STE 250",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BOULDER",
    "PracticeLocationAddressStateName": "CO",
    "PracticeLocationAddressPostalCode": "80303-8212",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "303-746-7844",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/15/2021",
    "LastUpdateDate": "06/15/2021",
    "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": "101YP2500X",
          "TaxonomyName": "Professional Counselor",
          "LicenseNumber": "82375",
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YP2500X",
          "TaxonomyName": "Professional Counselor",
          "LicenseNumber": "LPC0017108",
          "LicenseNumberStateCode": "CO",
          "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."
        },
        {
          "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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