1669662490 NPI number — CRYSTAL V AMUNDSON MS, LCPC, RPT-S

NPI Number: 1669662490
Health Care Provider/Practitioner: CRYSTAL V AMUNDSON MS, LCPC, RPT-S

NPI Number : 1669662490 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1669662490",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "AMUNDSON",
    "FirstName": "CRYSTAL",
    "MiddleName": "V",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "MS, LCPC, RPT-S",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1220 AVENUE C APT C",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BILLINGS",
    "MailingAddressStateName": "MT",
    "MailingAddressPostalCode": "59102-3200",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "406-461-4632",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1220 AVENUE C APT C",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BILLINGS",
    "PracticeLocationAddressStateName": "MT",
    "PracticeLocationAddressPostalCode": "59102-3200",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "406-763-6884",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/27/2007",
    "LastUpdateDate": "04/04/2023",
    "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": "SWP-LCPC-LIC-1549",
        "LicenseNumberStateCode": "MT",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}