NPI Code Detail JSON Logo

1811547110 NPI number — STACEY ALYNN GLICK LMHC

NPI Number: 1811547110
Health Care Provider/Practitioner: STACEY ALYNN GLICK LMHC

Information about “1811547110” NPI (STACEY ALYNN GLICK LMHC) exists in 1811547110 in HTML format HTML  |  1811547110 in plain Text format TXT  |  1811547110 in PDF (Portable Document Format) PDF  |  1811547110 in an XML format XML  formats.

NPI Number : 1811547110 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1811547110",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GLICK",
    "FirstName": "STACEY",
    "MiddleName": "ALYNN",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LMHC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "23 BOURNE HAY RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SANDWICH",
    "MailingAddressStateName": "MA",
    "MailingAddressPostalCode": "02563-2762",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "508-577-9017",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "704 MAIN ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FALMOUTH",
    "PracticeLocationAddressStateName": "MA",
    "PracticeLocationAddressPostalCode": "02540-3200",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "508-457-3160",
    "PracticeLocationAddressFaxNumber": "508-457-1255",
    "EnumerationDate": "09/18/2019",
    "LastUpdateDate": "09/18/2019",
    "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": "101YM0800X",
        "TaxonomyName": "Mental Health Counselor",
        "LicenseNumber": "4046",
        "LicenseNumberStateCode": "MA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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