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1770138190 NPI number — SEAN MERRICK

NPI Number: 1770138190
Health Care Provider/Practitioner: SEAN MERRICK

Information about “1770138190” NPI (SEAN MERRICK) exists in 1770138190 in HTML format HTML  |  1770138190 in plain Text format TXT  |  1770138190 in PDF (Portable Document Format) PDF  |  1770138190 in an XML format XML  formats.

NPI Number : 1770138190 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1770138190",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MERRICK",
    "FirstName": "SEAN",
    "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": "565 BRUNSWICK RD STE 10",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "GRASS VALLEY",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "95945-9529",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "702-575-2754",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "565 BRUNSWICK RD STE 10",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "GRASS VALLEY",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "95945-9529",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "530-265-9057",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/02/2019",
    "LastUpdateDate": "01/20/2024",
    "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": "101Y00000X",
          "TaxonomyName": "Counselor",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "171M00000X",
          "TaxonomyName": "Case Manager/Care Coordinator",
          "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": "106H00000X",
          "TaxonomyName": "Marriage & Family Therapist",
          "LicenseNumber": "AMFT119806",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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