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1669623674 NPI number — KIA HOLLOWAY LPC

NPI Number: 1669623674
Health Care Provider/Practitioner: KIA HOLLOWAY LPC

Information about “1669623674” NPI (KIA HOLLOWAY LPC) exists in 1669623674 in HTML format HTML  |  1669623674 in plain Text format TXT  |  1669623674 in PDF (Portable Document Format) PDF  |  1669623674 in an XML format XML  formats.

NPI Number : 1669623674 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1669623674",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "HOLLOWAY",
    "FirstName": "KIA",
    "MiddleName": null,
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "LPC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "13500 W CAPITOL DR",
    "SecondLineMailingAddress": "SUITE 104",
    "MailingAddressCityName": "BROOKFIELD",
    "MailingAddressStateName": "WI",
    "MailingAddressPostalCode": "53005-2444",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "414-737-1820",
    "MailingAddressFaxNumber": "414-455-5405",
    "FirstLinePracticeLocationAddress": "13500 W CAPITOL DR",
    "SecondLinePracticeLocationAddress": "SUITE 104",
    "PracticeLocationAddressCityName": "BROOKFIELD",
    "PracticeLocationAddressStateName": "WI",
    "PracticeLocationAddressPostalCode": "53005-2444",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "414-737-1820",
    "PracticeLocationAddressFaxNumber": "414-455-5405",
    "EnumerationDate": "10/08/2008",
    "LastUpdateDate": "04/18/2013",
    "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": "101YP2500X",
        "TaxonomyName": "Professional Counselor",
        "LicenseNumber": "4137-125",
        "LicenseNumberStateCode": "WI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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