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1700054624 NPI number — JILL RANDALL LPC

NPI Number: 1700054624
Health Care Provider/Practitioner: JILL RANDALL LPC

Information about “1700054624” NPI (JILL RANDALL LPC) exists in 1700054624 in HTML format HTML  |  1700054624 in plain Text format TXT  |  1700054624 in PDF (Portable Document Format) PDF  |  1700054624 in an XML format XML  formats.

NPI Number : 1700054624 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1700054624",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "RANDALL",
    "FirstName": "JILL",
    "MiddleName": null,
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "LPC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "RANDALL",
    "OtherFirstName": "JILL",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "LPC",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "109 WATERBERRY DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BROUSSARD",
    "MailingAddressStateName": "LA",
    "MailingAddressPostalCode": "70518-9104",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "337-837-1126",
    "MailingAddressFaxNumber": "337-205-8669",
    "FirstLinePracticeLocationAddress": "800 KALISTE SALOOM RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LAFAYETTE",
    "PracticeLocationAddressStateName": "LA",
    "PracticeLocationAddressPostalCode": "70508-4210",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "337-718-7737",
    "PracticeLocationAddressFaxNumber": "337-205-8669",
    "EnumerationDate": "02/13/2008",
    "LastUpdateDate": "08/20/2019",
    "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": "101Y00000X",
        "TaxonomyName": "Counselor",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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