NPI Code Detail JSON Logo

1639666837 NPI number — CREATIVE WELLNESS INSTITUTE

NPI Number: 1639666837
Health Care Provider/Practitioner: CREATIVE WELLNESS INSTITUTE

Information about “1639666837” NPI (CREATIVE WELLNESS INSTITUTE) exists in 1639666837 in HTML format HTML  |  1639666837 in plain Text format TXT  |  1639666837 in PDF (Portable Document Format) PDF  |  1639666837 in an XML format XML  formats.

NPI Number : 1639666837 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1639666837",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "CREATIVE WELLNESS INSTITUTE",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "4001 DON TOMASO DR APT 1",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LOS ANGELES",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "90008-5319",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "602-299-4679",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1713 E WALNUT ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PASADENA",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "91106-1611",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "602-299-4679",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/13/2018",
    "LastUpdateDate": "04/13/2018",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "BEDNASH",
    "AuthorizedOfficialFirstName": "CECCILY",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "602-299-4679",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "251S00000X",
          "TaxonomyName": "Community/Behavioral Health Agency",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "252Y00000X",
          "TaxonomyName": "Early Intervention Provider Agency",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QD1600X",
          "TaxonomyName": "Developmental Disabilities Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QM0850X",
          "TaxonomyName": "Adult Mental Health Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QR0400X",
          "TaxonomyName": "Rehabilitation Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QM0855X",
          "TaxonomyName": "Adolescent and Children Mental Health Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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