NPI Code Detail JSON Logo

1629668165 NPI number — KATIE ANN MCKELVY-GIBBONS MA, LCPC

NPI Number: 1629668165
Health Care Provider/Practitioner: KATIE ANN MCKELVY-GIBBONS MA, LCPC

Information about “1629668165” NPI (KATIE ANN MCKELVY-GIBBONS MA, LCPC) exists in 1629668165 in HTML format HTML  |  1629668165 in plain Text format TXT  |  1629668165 in PDF (Portable Document Format) PDF  |  1629668165 in an XML format XML  formats.

NPI Number : 1629668165 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1629668165",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MCKELVY-GIBBONS",
    "FirstName": "KATIE",
    "MiddleName": "ANN",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MA, LCPC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "202 E JACKSON ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "O FALLON",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "62269-1318",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "618-920-6119",
    "MailingAddressFaxNumber": "618-288-4669",
    "FirstLinePracticeLocationAddress": "200 N LINCOLN AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "O FALLON",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "62269-1415",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "618-920-6119",
    "PracticeLocationAddressFaxNumber": "618-288-4669",
    "EnumerationDate": "01/19/2021",
    "LastUpdateDate": "08/23/2023",
    "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": "178.014311",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YP2500X",
          "TaxonomyName": "Professional Counselor",
          "LicenseNumber": "180.015303",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

Copyright © 2007-2026 Data Labs Health. All rights reserved.