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1962915579 NPI number — COLLABORATIVE COUNSELING GROUP

NPI Number: 1962915579
Health Care Provider/Practitioner: COLLABORATIVE COUNSELING GROUP

Information about “1962915579” NPI (COLLABORATIVE COUNSELING GROUP) exists in 1962915579 in HTML format HTML  |  1962915579 in plain Text format TXT  |  1962915579 in PDF (Portable Document Format) PDF  |  1962915579 in an XML format XML  formats.

NPI Number : 1962915579 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1962915579",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "COLLABORATIVE COUNSELING GROUP",
    "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": "202 N MULBERRY ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ELIZABETHTOWN",
    "MailingAddressStateName": "KY",
    "MailingAddressPostalCode": "42701-1441",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "270-312-2860",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "208 N MULBERRY ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ELIZABETHTOWN",
    "PracticeLocationAddressStateName": "KY",
    "PracticeLocationAddressPostalCode": "42701-1464",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "270-312-2860",
    "PracticeLocationAddressFaxNumber": "270-312-2860",
    "EnumerationDate": "11/06/2017",
    "LastUpdateDate": "01/24/2018",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "LONNEMAN",
    "AuthorizedOfficialFirstName": "PHYLLIS",
    "AuthorizedOfficialMiddleName": "K",
    "AuthorizedOfficialTitle": "CEO",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "LPCC",
    "AuthorizedOfficialTelephoneNumber": "270-234-0267",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "251S00000X",
        "TaxonomyName": "Community/Behavioral Health Agency",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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