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1649579780 NPI number — BRYANS COUNSELING SERVICE

NPI Number: 1649579780
Health Care Provider/Practitioner: BRYANS COUNSELING SERVICE

Information about “1649579780” NPI (BRYANS COUNSELING SERVICE) exists in 1649579780 in HTML format HTML  |  1649579780 in plain Text format TXT  |  1649579780 in PDF (Portable Document Format) PDF  |  1649579780 in an XML format XML  formats.

NPI Number : 1649579780 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1649579780",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "BRYANS COUNSELING SERVICE",
    "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": "2891 CLARK CT",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SANTA FE",
    "MailingAddressStateName": "NM",
    "MailingAddressPostalCode": "87507-5179",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "505-930-4550",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2891 CLARK CT",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SANTA FE",
    "PracticeLocationAddressStateName": "NM",
    "PracticeLocationAddressPostalCode": "87507-5179",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "505-930-4550",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/15/2011",
    "LastUpdateDate": "03/15/2011",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "STUPPY",
    "AuthorizedOfficialFirstName": "JOHN",
    "AuthorizedOfficialMiddleName": "BRYAN",
    "AuthorizedOfficialTitle": "CLINICAL SOCIAL WORKE",
    "AuthorizedOfficialNamePrefix": "MR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "LISW/LADAC",
    "AuthorizedOfficialTelephoneNumber": "505-930-4550",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "251S00000X",
        "TaxonomyName": "Community/Behavioral Health Agency",
        "LicenseNumber": "I-06160",
        "LicenseNumberStateCode": "NM",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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