1932154069 NPI number — JOHN SAMUEL MARSHALL III LPC

Table of content: JOHN SAMUEL MARSHALL III LPC (NPI 1932154069)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932154069 NPI number — JOHN SAMUEL MARSHALL III LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARSHALL
Provider First Name:
JOHN
Provider Middle Name:
SAMUEL
Provider Name Prefix Text:
Provider Name Suffix Text:
III
Provider Credential Text:
LPC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932154069
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/01/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
605 BEL AIR BLVD.
Provider Second Line Business Mailing Address:
SUITE 24
Provider Business Mailing Address City Name:
MOBILE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36606-3528
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-342-7066
Provider Business Mailing Address Fax Number:
251-342-0152

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
605 BEL AIR BLVD.
Provider Second Line Business Practice Location Address:
SUITE 24
Provider Business Practice Location Address City Name:
MOBILE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36606-3528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-342-7066
Provider Business Practice Location Address Fax Number:
251-342-0152
Provider Enumeration Date:
05/24/2006

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: 103TC1900X , with the licence number:  1731 , 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: 99114 . This is a "BCBD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com