{
"Npi": {
"NPI": "1033312285",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "TRACY",
"FirstName": "MICHAEL",
"MiddleName": "W",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "LCSW",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1350 MANSE RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PAHRUMP",
"MailingAddressStateName": "NV",
"MailingAddressPostalCode": "89048-6824",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "801-888-2935",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "6900 N PECOS RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "NORTH LAS VEGAS",
"PracticeLocationAddressStateName": "NV",
"PracticeLocationAddressPostalCode": "89086-4400",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "801-888-2935",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/06/2007",
"LastUpdateDate": "09/26/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "1041C0700X",
"TaxonomyName": "Clinical Social Worker",
"LicenseNumber": "LCSW-712",
"LicenseNumberStateCode": "WY",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "1041C0700X",
"TaxonomyName": "Clinical Social Worker",
"LicenseNumber": "8566-C",
"LicenseNumberStateCode": "NV",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "1041C0700X",
"TaxonomyName": "Clinical Social Worker",
"LicenseNumber": "5970944-3501",
"LicenseNumberStateCode": "UT",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}