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1720388200 NPI number — KENYA R MCCRAY LISAC

NPI Number: 1720388200
Health Care Provider/Practitioner: KENYA R MCCRAY LISAC

Information about “1720388200” NPI (KENYA R MCCRAY LISAC) exists in 1720388200 in HTML format HTML  |  1720388200 in plain Text format TXT  |  1720388200 in PDF (Portable Document Format) PDF  |  1720388200 in an XML format XML  formats.

NPI Number : 1720388200 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1720388200",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MCCRAY",
    "FirstName": "KENYA",
    "MiddleName": "R",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LISAC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 3160",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "APACHE JUNCTION",
    "MailingAddressStateName": "AZ",
    "MailingAddressPostalCode": "85117-4115",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "928-344-9490",
    "MailingAddressFaxNumber": "480-288-5339",
    "FirstLinePracticeLocationAddress": "290 S 1ST AVE STE 3",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "YUMA",
    "PracticeLocationAddressStateName": "AZ",
    "PracticeLocationAddressPostalCode": "85364-2260",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "928-344-9490",
    "PracticeLocationAddressFaxNumber": "480-288-5339",
    "EnumerationDate": "10/29/2010",
    "LastUpdateDate": "02/10/2023",
    "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": "101YA0400X",
          "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
          "LicenseNumber": "LISAC-10480",
          "LicenseNumberStateCode": "AZ",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": "10480",
          "LicenseNumberStateCode": "AZ",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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