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1659762078 NPI number — SUZANNE M LARSEN LCPC

NPI Number: 1659762078
Health Care Provider/Practitioner: SUZANNE M LARSEN LCPC

Information about “1659762078” NPI (SUZANNE M LARSEN LCPC) exists in 1659762078 in HTML format HTML  |  1659762078 in plain Text format TXT  |  1659762078 in PDF (Portable Document Format) PDF  |  1659762078 in an XML format XML  formats.

NPI Number : 1659762078 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1659762078",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LARSEN",
    "FirstName": "SUZANNE",
    "MiddleName": "M",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "LCPC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3856 W DAISY CREEK ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MERIDIAN",
    "MailingAddressStateName": "ID",
    "MailingAddressPostalCode": "83642-7969",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "208-982-9796",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "403 W CHERRY LN",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MERIDIAN",
    "PracticeLocationAddressStateName": "ID",
    "PracticeLocationAddressPostalCode": "83642-1610",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "208-887-1911",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "02/06/2015",
    "LastUpdateDate": "08/26/2020",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": "LPC-5615",
          "LicenseNumberStateCode": "ID",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": "LCPC-7519",
          "LicenseNumberStateCode": "ID",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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