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1730574013 NPI number — ADULT AND YOUTH SERVICES, P.L.L.C.

NPI Number: 1730574013
Health Care Provider/Practitioner: ADULT AND YOUTH SERVICES, P.L.L.C.

Information about “1730574013” NPI (ADULT AND YOUTH SERVICES, P.L.L.C.) exists in 1730574013 in HTML format HTML  |  1730574013 in plain Text format TXT  |  1730574013 in PDF (Portable Document Format) PDF  |  1730574013 in an XML format XML  formats.

NPI Number : 1730574013 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1730574013",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "ADULT AND YOUTH SERVICES, P.L.L.C.",
    "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": "PO BOX 44",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DAVIS",
    "MailingAddressStateName": "WV",
    "MailingAddressPostalCode": "26260-0044",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "304-257-8232",
    "MailingAddressFaxNumber": "304-636-4200",
    "FirstLinePracticeLocationAddress": "1200 HARRISON AVE.",
    "SecondLinePracticeLocationAddress": "SUITE 121",
    "PracticeLocationAddressCityName": "ELKINS",
    "PracticeLocationAddressStateName": "WV",
    "PracticeLocationAddressPostalCode": "26241-3392",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "304-636-4200",
    "PracticeLocationAddressFaxNumber": "304-636-4200",
    "EnumerationDate": "04/02/2015",
    "LastUpdateDate": "04/02/2015",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "NUGENT",
    "AuthorizedOfficialFirstName": "DANA",
    "AuthorizedOfficialMiddleName": "A",
    "AuthorizedOfficialTitle": "OWNER/PSYCHOLOGIST",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "ED. D.",
    "AuthorizedOfficialTelephoneNumber": "304-257-8232",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "103TC0700X",
          "TaxonomyName": "Clinical Psychologist",
          "LicenseNumber": "999",
          "LicenseNumberStateCode": "WV",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "103T00000X",
          "TaxonomyName": "Psychologist",
          "LicenseNumber": "2304-8074",
          "LicenseNumberStateCode": "WV",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        }
      ]
    }
  }
}
                
            

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