1306916911 NPI number — CLAIRE L PRESTON LCSW

Table of content: CLAIRE L PRESTON LCSW (NPI 1306916911)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306916911 NPI number — CLAIRE L PRESTON LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRESTON
Provider First Name:
CLAIRE
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LOWERY
Provider Other First Name:
CLAIRE
Provider Other Middle Name:
P
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1306916911
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/24/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 97
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GADSDEN
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35902-0097
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-492-0131
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8225 AL HIGHWAY 75
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HORTON
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35980-8473
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-593-3804
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  2165C , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 51594755 . This is a "BLUE CROSS AND BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 511-59442 . This is a "BLUE CROSS (CULLMAN)" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 330000025 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 511-59443 . This is a "BLUE CROSS (DOUGLAS)" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 193484 (CULLMAN) , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 176508 (DOUGLAS) , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com