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1679425219 NPI number — JRP COUNSELING LICENSED CLINICAL SOCIAL WORKER PROFESSIONAL

NPI Number: 1679425219
Health Care Provider/Practitioner: JRP COUNSELING LICENSED CLINICAL SOCIAL WORKER PROFESSIONAL

Information about “1679425219” NPI (JRP COUNSELING LICENSED CLINICAL SOCIAL WORKER PROFESSIONAL) exists in 1679425219 in HTML format HTML  |  1679425219 in plain Text format TXT  |  1679425219 in PDF (Portable Document Format) PDF  |  1679425219 in an XML format XML  formats.

NPI Number : 1679425219 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1679425219",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "JRP COUNSELING LICENSED CLINICAL SOCIAL WORKER PROFESSIONAL",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1010 LYRA WAY",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BEAUMONT",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "92223-2079",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "951-305-3071",
    "MailingAddressFaxNumber": "951-602-6006",
    "FirstLinePracticeLocationAddress": "1091 N PALM CANYON DR STE 11",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PALM SPRINGS",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92262-4419",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "951-305-3071",
    "PracticeLocationAddressFaxNumber": "951-602-6006",
    "EnumerationDate": "02/13/2026",
    "LastUpdateDate": "02/13/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "RUGALA PERSICONE",
    "AuthorizedOfficialFirstName": "JENNIFER",
    "AuthorizedOfficialMiddleName": "NICOLE",
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "LCSW",
    "AuthorizedOfficialTelephoneNumber": "951-255-1754",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "101YM0800X",
        "TaxonomyName": "Mental Health Counselor",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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