NPI Code Detail JSON Logo

1700753639 NPI number — CHILD AND ADOLESCENT PSYCHOLOGICAL AND COUNSELING SERVICES OF NW FLORIDA, LLC

NPI Number: 1700753639
Health Care Provider/Practitioner: CHILD AND ADOLESCENT PSYCHOLOGICAL AND COUNSELING SERVICES OF NW FLORIDA, LLC

Information about “1700753639” NPI (CHILD AND ADOLESCENT PSYCHOLOGICAL AND COUNSELING SERVICES OF NW FLORIDA, LLC) exists in 1700753639 in HTML format HTML  |  1700753639 in plain Text format TXT  |  1700753639 in PDF (Portable Document Format) PDF  |  1700753639 in an XML format XML  formats.

NPI Number : 1700753639 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1700753639",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "CHILD AND ADOLESCENT PSYCHOLOGICAL AND COUNSELING SERVICES OF NW FLORIDA, LLC",
    "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": "336 FORT PICKENS RD APT E206",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PENSACOLA BEACH",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "32561-2048",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "850-207-7671",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "336 FORT PICKENS RD APT E206",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PENSACOLA BEACH",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "32561-2048",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "850-207-7671",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/23/2025",
    "LastUpdateDate": "10/23/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "SHOUMAKER",
    "AuthorizedOfficialFirstName": "DOUGLAS",
    "AuthorizedOfficialMiddleName": "BERRY",
    "AuthorizedOfficialTitle": "PSYCHOLOGIST/OWNER",
    "AuthorizedOfficialNamePrefix": "MR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "PSYS. LSP, NCSP",
    "AuthorizedOfficialTelephoneNumber": "850-207-7671",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "103T00000X",
        "TaxonomyName": "Psychologist",
        "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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