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1922136001 NPI number — CRYSTAL TERESE HENSON MA

NPI Number: 1922136001
Health Care Provider/Practitioner: CRYSTAL TERESE HENSON MA

Information about “1922136001” NPI (CRYSTAL TERESE HENSON MA) exists in 1922136001 in HTML format HTML  |  1922136001 in plain Text format TXT  |  1922136001 in PDF (Portable Document Format) PDF  |  1922136001 in an XML format XML  formats.

NPI Number : 1922136001 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1922136001",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "HENSON",
    "FirstName": "CRYSTAL",
    "MiddleName": "TERESE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1735 SPRINGFIELD HWY",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "GOODLETTSVILLE",
    "MailingAddressStateName": "TN",
    "MailingAddressPostalCode": "37072-9191",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "615-310-6210",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "6000 POPLAR AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MEMPHIS",
    "PracticeLocationAddressStateName": "TN",
    "PracticeLocationAddressPostalCode": "38119-3981",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "574-546-1900",
    "PracticeLocationAddressFaxNumber": "574-546-1999",
    "EnumerationDate": "03/01/2007",
    "LastUpdateDate": "12/19/2024",
    "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": "103TC0700X",
          "TaxonomyName": "Clinical Psychologist",
          "LicenseNumber": "268285",
          "LicenseNumberStateCode": "KY",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "103TC0700X",
          "TaxonomyName": "Clinical Psychologist",
          "LicenseNumber": "3824",
          "LicenseNumberStateCode": "TN",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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