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1922306604 NPI number — JULIA ANN LESSELYONG PSYD

NPI Number: 1922306604
Health Care Provider/Practitioner: JULIA ANN LESSELYONG PSYD

Information about “1922306604” NPI (JULIA ANN LESSELYONG PSYD) exists in 1922306604 in HTML format HTML  |  1922306604 in plain Text format TXT  |  1922306604 in PDF (Portable Document Format) PDF  |  1922306604 in an XML format XML  formats.

NPI Number : 1922306604 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1922306604",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LESSELYONG",
    "FirstName": "JULIA",
    "MiddleName": "ANN",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PSYD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "125 N 2ND ST",
    "SecondLineMailingAddress": "SUITE 110 #532",
    "MailingAddressCityName": "PHOENIX",
    "MailingAddressStateName": "AZ",
    "MailingAddressPostalCode": "85004-2422",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "480-442-8510",
    "MailingAddressFaxNumber": "480-907-2130",
    "FirstLinePracticeLocationAddress": "125 N 2ND ST",
    "SecondLinePracticeLocationAddress": "SUITE 110 #532",
    "PracticeLocationAddressCityName": "PHOENIX",
    "PracticeLocationAddressStateName": "AZ",
    "PracticeLocationAddressPostalCode": "85004-2422",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "480-442-8510",
    "PracticeLocationAddressFaxNumber": "480-907-2130",
    "EnumerationDate": "03/04/2011",
    "LastUpdateDate": "10/16/2012",
    "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": "103TA0700X",
        "TaxonomyName": "Adult Development & Aging Psychologist",
        "LicenseNumber": "4175",
        "LicenseNumberStateCode": "AZ",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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