{
"Npi": {
"NPI": "1023455268",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "FORREIDER",
"FirstName": "MARY",
"MiddleName": "ANN",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "MA, LAC, LMFT",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "URSICH",
"OtherFirstName": "MARY",
"OtherMiddleName": "A",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "PHD, LMFT",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "1751 HOVER ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LONGMONT",
"MailingAddressStateName": "CO",
"MailingAddressPostalCode": "80501-7181",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "303-834-9369",
"MailingAddressFaxNumber": "303-834-9396",
"FirstLinePracticeLocationAddress": "420 21ST AVE STE 113",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LONGMONT",
"PracticeLocationAddressStateName": "CO",
"PracticeLocationAddressPostalCode": "80501-1441",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "303-834-9369",
"PracticeLocationAddressFaxNumber": "303-834-9396",
"EnumerationDate": "05/29/2013",
"LastUpdateDate": "12/27/2025",
"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": "101YA0400X",
"TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
"LicenseNumber": "ACD.0000339",
"LicenseNumberStateCode": "CO",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "106H00000X",
"TaxonomyName": "Marriage & Family Therapist",
"LicenseNumber": "MFT.0001573",
"LicenseNumberStateCode": "CO",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}