1912663840 NPI number — CHERYL L PENCE PHD, LPC, LPCC-S,NCC

NPI Number: 1912663840
Health Care Provider/Practitioner: CHERYL L PENCE PHD, LPC, LPCC-S,NCC

NPI Number : 1912663840 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1912663840",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PENCE",
    "FirstName": "CHERYL",
    "MiddleName": "L",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "PHD, LPC, LPCC-S,NCC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "WOLF",
    "OtherFirstName": "CHERYL",
    "OtherMiddleName": "PENCE",
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": null,
    "OtherCredential": "PHD, LPC, LPCC-S,NCC",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "611 W COUPLES DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "COTTONWOOD",
    "MailingAddressStateName": "AZ",
    "MailingAddressPostalCode": "86326-4252",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "352-870-1135",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "12530 E ST FRANCIS WAY",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CORNVILLE",
    "PracticeLocationAddressStateName": "AZ",
    "PracticeLocationAddressPostalCode": "86325-5950",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "601-207-4554",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/15/2021",
    "LastUpdateDate": "11/15/2021",
    "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": "101YP2500X",
          "TaxonomyName": "Professional Counselor",
          "LicenseNumber": "LPCC-S-252425",
          "LicenseNumberStateCode": "KY",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YP2500X",
          "TaxonomyName": "Professional Counselor",
          "LicenseNumber": "LPC-19977",
          "LicenseNumberStateCode": "AZ",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}