NPIMap

Organization Active NPI

Bare Ones Soul

  • Psychologist
  • Huntersville, NC
National Provider Identifier
1841579240
Registry record updated Oct 31, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
BARE ONES SOUL
Practice address
15411 Tuxford Dr
Huntersville, NC 28078-3713
Phone
(704) 813-4033
NPI assigned
Aug 16, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Bernard Sullivan, PHDNPI 1326282633
Title
Owner
Phone
(704) 813-4033

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103T00000X Primary

Addresses

Primary practice location

15411 Tuxford Dr
Huntersville, NC 28078-3713

Mailing address

15411 Tuxford Dr
Huntersville, NC 28078-3713
Phone (704) 813-4033

Other identifiers 1

IdentifierTypeStateIssuer
6001164MedicaidNC

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1313452800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320019200000",
    "number": "1841579240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15411 TUXFORD DR",
            "city": "HUNTERSVILLE",
            "state": "NC",
            "postal_code": "280783713",
            "telephone_number": "704-813-4033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15411 TUXFORD DR",
            "city": "HUNTERSVILLE",
            "state": "NC",
            "postal_code": "280783713",
            "telephone_number": "704-813-4033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BARE ONES SOUL",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-16",
        "last_updated": "2011-10-31",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "BERNARD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "704-813-4033",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6001164",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Huntersville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.