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1922401769 NPI number — TAMMIE SUE MAKELY

NPI Number: 1922401769
Health Care Provider/Practitioner: TAMMIE SUE MAKELY

Information about “1922401769” NPI (TAMMIE SUE MAKELY) exists in 1922401769 in HTML format HTML  |  1922401769 in plain Text format TXT  |  1922401769 in PDF (Portable Document Format) PDF  |  1922401769 in an XML format XML  formats.

NPI Number : 1922401769 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1922401769",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MAKELY",
    "FirstName": "TAMMIE",
    "MiddleName": "SUE",
    "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": "2540 W SHAW LN STE 107",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FRESNO",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "93711-2700",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "559-256-7666",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "550 W ALLUVIAL AVE STE 108",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FRESNO",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "93711-5857",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "559-761-9724",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/07/2014",
    "LastUpdateDate": "07/17/2019",
    "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": "106H00000X",
          "TaxonomyName": "Marriage & Family Therapist",
          "LicenseNumber": "75056",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": null,
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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