{
"Npi": {
"NPI": "1003320524",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MINDFUL SOLUTIONS THERAPY, LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1311 WILDWOOD LAKES BLVD UNIT 2",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NAPLES",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "34104-6457",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "239-307-8038",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "4532 TAMIAMI TRL E STE 302",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "NAPLES",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "34112-6784",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "239-307-8038",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "11/20/2017",
"LastUpdateDate": "11/20/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KARDANOW",
"AuthorizedOfficialFirstName": "KRISTINA",
"AuthorizedOfficialMiddleName": "L",
"AuthorizedOfficialTitle": "CLINICIAN",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LCSW",
"AuthorizedOfficialTelephoneNumber": "239-307-8038",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251S00000X",
"TaxonomyName": "Community/Behavioral Health Agency",
"LicenseNumber": "11649",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}