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1639894306 NPI number — JEFFREY DOUGLAS COIRA LCSW-S, LCDC, CST

NPI Number: 1639894306
Health Care Provider/Practitioner: JEFFREY DOUGLAS COIRA LCSW-S, LCDC, CST

Information about “1639894306” NPI (JEFFREY DOUGLAS COIRA LCSW-S, LCDC, CST) exists in 1639894306 in HTML format HTML  |  1639894306 in plain Text format TXT  |  1639894306 in PDF (Portable Document Format) PDF  |  1639894306 in an XML format XML  formats.

NPI Number : 1639894306 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1639894306",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "COIRA",
    "FirstName": "JEFFREY",
    "MiddleName": "DOUGLAS",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LCSW-S, LCDC, CST",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "SKAGGS",
    "OtherFirstName": "JEFFREY",
    "OtherMiddleName": "DOUGLAS",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "LCSW-S, LCDC, CST",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "5528 HOLLY SPRINGS DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "HOUSTON",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "77056-2024",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "713-364-4155",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "303 JACKSON HILL ST FL 2",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "HOUSTON",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "77007-7407",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "713-364-4155",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/05/2022",
    "LastUpdateDate": "02/26/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "1041C0700X",
          "TaxonomyName": "Clinical Social Worker",
          "LicenseNumber": "105158",
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "101YA0400X",
          "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
          "LicenseNumber": "15589",
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "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."
      }
    }
  }
}
                
            

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