{
"Npi": {
"NPI": "1023676913",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BROADRIGHT COUNSELING SERVICES, 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": "1403 FANTAIL LANE",
"SecondLineMailingAddress": "FANTAIL LANE",
"MailingAddressCityName": "ENNIS",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "75119-6968",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "719-685-6729",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1403 FANTAIL LANE",
"SecondLinePracticeLocationAddress": "FANTAIL LANE",
"PracticeLocationAddressCityName": "ENNIS",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "75119-6968",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "719-685-6729",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/05/2019",
"LastUpdateDate": "10/22/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BROADRIGHT",
"AuthorizedOfficialFirstName": "TRISHA",
"AuthorizedOfficialMiddleName": "DANIELLE",
"AuthorizedOfficialTitle": "LICENSED PROFESSIONAL COUNSELOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MA, LPC",
"AuthorizedOfficialTelephoneNumber": "719-685-6729",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QM0801X",
"TaxonomyName": "Mental Health Clinic/Center (Including Community Mental Health Center)",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}