NPI Code Detail JSON Logo

1659606705 NPI number — MICHELLE MOORE, PHD, LLC

NPI Number: 1659606705
Health Care Provider/Practitioner: MICHELLE MOORE, PHD, LLC

Information about “1659606705” NPI (MICHELLE MOORE, PHD, LLC) exists in 1659606705 in HTML format HTML  |  1659606705 in plain Text format TXT  |  1659606705 in PDF (Portable Document Format) PDF  |  1659606705 in an XML format XML  formats.

NPI Number : 1659606705 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1659606705",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "MICHELLE MOORE, PHD, LLC",
    "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": "1710 BEARBERRY CIR APT 101",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LUTZ",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "33559-8781",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "303-345-3728",
    "MailingAddressFaxNumber": "888-868-5424",
    "FirstLinePracticeLocationAddress": "1710 BEARBERRY CIR APT 101",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LUTZ",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33559-8781",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "303-345-3728",
    "PracticeLocationAddressFaxNumber": "888-868-5424",
    "EnumerationDate": "10/07/2009",
    "LastUpdateDate": "06/14/2012",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "WIDOWS",
    "AuthorizedOfficialFirstName": "MICHELLE",
    "AuthorizedOfficialMiddleName": "RENEE",
    "AuthorizedOfficialTitle": "CLINICAL PSYCHOLOGIST",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "PHD",
    "AuthorizedOfficialTelephoneNumber": "303-345-3728",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "103T00000X",
          "TaxonomyName": "Psychologist",
          "LicenseNumber": "3155",
          "LicenseNumberStateCode": "CO",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "103TC0700X",
          "TaxonomyName": "Clinical Psychologist",
          "LicenseNumber": "3155",
          "LicenseNumberStateCode": "CO",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "103TH0004X",
          "TaxonomyName": "Health Psychologist",
          "LicenseNumber": "3155",
          "LicenseNumberStateCode": "CO",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "103TC0700X",
          "TaxonomyName": "Clinical Psychologist",
          "LicenseNumber": "PY6699",
          "LicenseNumberStateCode": "FL",
          "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."
        },
        {
          "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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