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1811754997 NPI number — SAGE & LORE COUNSELING

NPI Number: 1811754997
Health Care Provider/Practitioner: SAGE & LORE COUNSELING

Information about “1811754997” NPI (SAGE & LORE COUNSELING) exists in 1811754997 in HTML format HTML  |  1811754997 in plain Text format TXT  |  1811754997 in PDF (Portable Document Format) PDF  |  1811754997 in an XML format XML  formats.

NPI Number : 1811754997 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1811754997",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "SAGE & LORE COUNSELING",
    "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": "4085 HANCOCK BRIDGE PKWY STE 112-116",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "NORTH FORT MYERS",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "33903-7219",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1404 DEL PRADO BLVD S",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CAPE CORAL",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33990-3774",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "978-310-1212",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/05/2024",
    "LastUpdateDate": "03/05/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "WILKES",
    "AuthorizedOfficialFirstName": "PETRA",
    "AuthorizedOfficialMiddleName": "P",
    "AuthorizedOfficialTitle": "THERAPIST",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MFT, MHC",
    "AuthorizedOfficialTelephoneNumber": "978-310-1212",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "101YM0800X",
        "TaxonomyName": "Mental Health Counselor",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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