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1801508528 NPI number — A BRIDGE 2 HEALING THERAPEUTIC SERVICES

NPI Number: 1801508528
Health Care Provider/Practitioner: A BRIDGE 2 HEALING THERAPEUTIC SERVICES

Information about “1801508528” NPI (A BRIDGE 2 HEALING THERAPEUTIC SERVICES) exists in 1801508528 in HTML format HTML  |  1801508528 in plain Text format TXT  |  1801508528 in PDF (Portable Document Format) PDF  |  1801508528 in an XML format XML  formats.

NPI Number : 1801508528 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1801508528",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "A BRIDGE 2 HEALING THERAPEUTIC SERVICES",
    "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": "12254 S YALE AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CHICAGO",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60628-6529",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "708-831-3943",
    "MailingAddressFaxNumber": "708-794-0521",
    "FirstLinePracticeLocationAddress": "930 175TH ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "HOMEWOOD",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60430-2039",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "708-831-3943",
    "PracticeLocationAddressFaxNumber": "708-794-0521",
    "EnumerationDate": "12/14/2022",
    "LastUpdateDate": "10/06/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "MORRIS",
    "AuthorizedOfficialFirstName": "ENCHELLE",
    "AuthorizedOfficialMiddleName": "R",
    "AuthorizedOfficialTitle": "OWNER/CLINICAL THERAPIST",
    "AuthorizedOfficialNamePrefix": "MISS",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "LCPC",
    "AuthorizedOfficialTelephoneNumber": "708-831-3943",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "261QM0801X",
          "TaxonomyName": "Mental Health Clinic/Center (Including Community Mental Health Center)",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YA0400X",
          "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "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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