{
"Npi": {
"NPI": "1003470303",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "MOORE",
"FirstName": "LISA",
"MiddleName": "BETH",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "LPC-IT",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 1298",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WOODRUFF",
"MailingAddressStateName": "WI",
"MailingAddressPostalCode": "54568-1298",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "262-364-4968",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "101 W BROADWAY FL 2",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WAUKESHA",
"PracticeLocationAddressStateName": "WI",
"PracticeLocationAddressPostalCode": "53186-4833",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "262-547-5567",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/23/2019",
"LastUpdateDate": "04/23/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "101YP2500X",
"TaxonomyName": "Professional Counselor",
"LicenseNumber": "3523-266",
"LicenseNumberStateCode": "WI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}