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1992460356 NPI number — SHACOLBY J DEDMOND MED, LPC

NPI Number: 1992460356
Health Care Provider/Practitioner: SHACOLBY J DEDMOND MED, LPC

Information about “1992460356” NPI (SHACOLBY J DEDMOND MED, LPC) exists in 1992460356 in HTML format HTML  |  1992460356 in plain Text format TXT  |  1992460356 in PDF (Portable Document Format) PDF  |  1992460356 in an XML format XML  formats.

NPI Number : 1992460356 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1992460356",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "DEDMOND",
    "FirstName": "SHACOLBY",
    "MiddleName": "J",
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "MED, LPC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3835 N FREEWAY BLVD STE 100",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SACRAMENTO",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "95834-1954",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "916-576-7900",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "24275 KATY FWY STE 410",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "KATY",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "77494-7267",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "855-501-1004",
    "PracticeLocationAddressFaxNumber": "844-708-1274",
    "EnumerationDate": "11/01/2021",
    "LastUpdateDate": "07/29/2024",
    "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": "101YP2500X",
          "TaxonomyName": "Professional Counselor",
          "LicenseNumber": "82698",
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": "82698",
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

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