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1669846234 NPI number — CRYSTAL MICHELLE SHIMIZU M.A., BCBA, LBA

NPI Number: 1669846234
Health Care Provider/Practitioner: CRYSTAL MICHELLE SHIMIZU M.A., BCBA, LBA

Information about “1669846234” NPI (CRYSTAL MICHELLE SHIMIZU M.A., BCBA, LBA) exists in 1669846234 in HTML format HTML  |  1669846234 in plain Text format TXT  |  1669846234 in PDF (Portable Document Format) PDF  |  1669846234 in an XML format XML  formats.

NPI Number : 1669846234 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1669846234",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SHIMIZU",
    "FirstName": "CRYSTAL",
    "MiddleName": "MICHELLE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "M.A., BCBA, LBA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "SHIMIZU",
    "OtherFirstName": "CRYSTAL",
    "OtherMiddleName": "MICHELLE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "19517 138TH AVE SE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "RENTON",
    "MailingAddressStateName": "WA",
    "MailingAddressPostalCode": "98058-7742",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "818-304-1313",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1201 PEACHTREE ST NE STE AND300",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ATLANTA",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "30361-3503",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "678-400-5040",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/19/2015",
    "LastUpdateDate": "09/26/2023",
    "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": "103K00000X",
          "TaxonomyName": "Behavior Analyst",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "103K00000X",
          "TaxonomyName": "Behavior Analyst",
          "LicenseNumber": "1-15-18868",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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