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1770216103 NPI number — TABATHA SUE MILLER LCSW

NPI Number: 1770216103
Health Care Provider/Practitioner: TABATHA SUE MILLER LCSW

Information about “1770216103” NPI (TABATHA SUE MILLER LCSW) exists in 1770216103 in HTML format HTML  |  1770216103 in plain Text format TXT  |  1770216103 in PDF (Portable Document Format) PDF  |  1770216103 in an XML format XML  formats.

NPI Number : 1770216103 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1770216103",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MILLER",
    "FirstName": "TABATHA",
    "MiddleName": "SUE",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "LCSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "MANSFIELD",
    "OtherFirstName": "TABATHA",
    "OtherMiddleName": "SUE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "10 REMINGTON DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LITTLE ROCK",
    "MailingAddressStateName": "AR",
    "MailingAddressPostalCode": "72204-8202",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "501-410-1567",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "9701 W MARKHAM ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LITTLE ROCK",
    "PracticeLocationAddressStateName": "AR",
    "PracticeLocationAddressPostalCode": "72205-2123",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "717-449-0458",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/04/2022",
    "LastUpdateDate": "07/04/2022",
    "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": "1041C0700X",
        "TaxonomyName": "Clinical Social Worker",
        "LicenseNumber": "7815-C",
        "LicenseNumberStateCode": "AR",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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