{
"Npi": {
"NPI": "1023929643",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "BOARD OF REGENTS NEVADA SYSTEM OF HIGHER EDUCATION",
"ParentOrgTIN": null,
"OrgName": "BOARD OF REGENTS NEVADA SYSTEM OF HIGHER EDUCATION",
"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": "4505 SOUTH MARYLAND PARKWAY",
"SecondLineMailingAddress": "CARLSON EDUCATION BUILDING #226; BOX 453033",
"MailingAddressCityName": "LAS VEGAS",
"MailingAddressStateName": "NV",
"MailingAddressPostalCode": "89154",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "702-895-0134",
"MailingAddressFaxNumber": "702-895-1530",
"FirstLinePracticeLocationAddress": "4505 SOUTH MARYLAND PARKWAY",
"SecondLinePracticeLocationAddress": "CARLSON EDUCATION BUILDING #226",
"PracticeLocationAddressCityName": "LAS VEGAS",
"PracticeLocationAddressStateName": "NV",
"PracticeLocationAddressPostalCode": "89154",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "702-895-1532",
"PracticeLocationAddressFaxNumber": "702-895-1530",
"EnumerationDate": "09/14/2026",
"LastUpdateDate": "09/14/2026",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PAUL",
"AuthorizedOfficialFirstName": "MICHELLE",
"AuthorizedOfficialMiddleName": "G",
"AuthorizedOfficialTitle": "EXECUTIVE DIRECTOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "702-895-0134",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QM0801X",
"TaxonomyName": "Mental Health Clinic/Center (Including Community Mental Health Center)",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}