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1639685241 NPI number — BEHAVIORAL HEALTH COLLABORATIVE

NPI Number: 1639685241
Health Care Provider/Practitioner: BEHAVIORAL HEALTH COLLABORATIVE

Information about “1639685241” NPI (BEHAVIORAL HEALTH COLLABORATIVE) exists in 1639685241 in HTML format HTML  |  1639685241 in plain Text format TXT  |  1639685241 in PDF (Portable Document Format) PDF  |  1639685241 in an XML format XML  formats.

NPI Number : 1639685241 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1639685241",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "BEHAVIORAL HEALTH COLLABORATIVE",
    "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": "10740 MERIDIAN AVE N STE 107",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SEATTLE",
    "MailingAddressStateName": "WA",
    "MailingAddressPostalCode": "98133-9010",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "206-432-9020",
    "MailingAddressFaxNumber": "206-432-9437",
    "FirstLinePracticeLocationAddress": "10740 MERIDIAN AVE N STE 107",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SEATTLE",
    "PracticeLocationAddressStateName": "WA",
    "PracticeLocationAddressPostalCode": "98133",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "206-432-9020",
    "PracticeLocationAddressFaxNumber": "206-432-9437",
    "EnumerationDate": "12/19/2017",
    "LastUpdateDate": "09/12/2018",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "LOLLEY",
    "AuthorizedOfficialFirstName": "JAMES",
    "AuthorizedOfficialMiddleName": "EDWARD",
    "AuthorizedOfficialTitle": "CO-OWNER",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "PSYD",
    "AuthorizedOfficialTelephoneNumber": "206-432-9020",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "103TC0700X",
          "TaxonomyName": "Clinical Psychologist",
          "LicenseNumber": "PY60345764",
          "LicenseNumberStateCode": "WA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2084P0800X",
          "TaxonomyName": "Psychiatry Physician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": "WA",
          "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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