Active NPI
Lothell Pack, M.A., ED.S.
- School Psychologist
- Logan, WV
National Provider Identifier
1750469185
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Psychologist
- License
- 21037
- Practice address
- 66 School St
Logan, WV 25601-9605 - Phone
- (304) 792-2087
- Fax
- (304) 752-7471
- NPI assigned
- Nov 2, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Psychologist | 103TS0200X | 21037 | WV | Primary |
Addresses
Primary practice location
66 School St
Logan, WV 25601-9605
Mailing address
66 School St
Logan, WV 25601-9605
Phone (304) 792-2087
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0166298000 | Medicaid | WV |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21037 | WV | MD | School Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162425600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1750469185",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "66 SCHOOL ST",
"city": "LOGAN",
"state": "WV",
"postal_code": "256019605",
"telephone_number": "304-792-2087",
"fax_number": "304-752-7471"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "66 SCHOOL ST",
"city": "LOGAN",
"state": "WV",
"postal_code": "256019605",
"telephone_number": "304-792-2087",
"fax_number": "304-752-7471"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PACK",
"first_name": "LOTHELL",
"name_prefix": "Mrs.",
"credential": "M.A., ED.S.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-11-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": "WV",
"license": "21037",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0166298000",
"state": "WV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Logan, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.