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1710649793 NPI number — PAX CHARLES MSW, LSWAIC

NPI Number: 1710649793
Health Care Provider/Practitioner: PAX CHARLES MSW, LSWAIC

Information about “1710649793” NPI (PAX CHARLES MSW, LSWAIC) exists in 1710649793 in HTML format HTML  |  1710649793 in plain Text format TXT  |  1710649793 in PDF (Portable Document Format) PDF  |  1710649793 in an XML format XML  formats.

NPI Number : 1710649793 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1710649793",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "CHARLES",
    "FirstName": "PAX",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MSW, LSWAIC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2415 NW 125TH ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "VANCOUVER",
    "MailingAddressStateName": "WA",
    "MailingAddressPostalCode": "98685-2029",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "360-433-7047",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "9120 NE VANCOUVER MALL DRIVE",
    "SecondLinePracticeLocationAddress": "STE #160",
    "PracticeLocationAddressCityName": "VANCOUVER",
    "PracticeLocationAddressStateName": "WA",
    "PracticeLocationAddressPostalCode": "98662-9401",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "360-891-5777",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/07/2021",
    "LastUpdateDate": "11/13/2023",
    "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": "101Y00000X",
          "TaxonomyName": "Counselor",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "390200000X",
          "TaxonomyName": "Student in an Organized Health Care Education/Training Program",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1041C0700X",
          "TaxonomyName": "Clinical Social Worker",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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