1720120983 NPI number — NABIL MICHAEL SAHURI L.P.C., L.C.P.C.

NPI Number: 1720120983
Health Care Provider/Practitioner: NABIL MICHAEL SAHURI L.P.C., L.C.P.C.

NPI Number : 1720120983 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1720120983",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SAHURI",
    "FirstName": "NABIL",
    "MiddleName": "MICHAEL",
    "NamePrefix": "MR.",
    "NameSuffix": null,
    "Credential": "L.P.C., L.C.P.C.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "402 OREGON ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BETHALTO",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "62010",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "618-978-4366",
    "MailingAddressFaxNumber": "314-351-2940",
    "FirstLinePracticeLocationAddress": "4561 S COMPTON AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SAINT LOUIS",
    "PracticeLocationAddressStateName": "MO",
    "PracticeLocationAddressPostalCode": "63111-1554",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "314-352-1770",
    "PracticeLocationAddressFaxNumber": "314-351-2940",
    "EnumerationDate": "02/13/2007",
    "LastUpdateDate": "07/09/2007",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "101YP2500X",
          "TaxonomyName": "Professional Counselor",
          "LicenseNumber": "2001031963",
          "LicenseNumberStateCode": "MO",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "101YP2500X",
          "TaxonomyName": "Professional Counselor",
          "LicenseNumber": null,
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}