{
"Npi": {
"NPI": "1033625462",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "LIFE BALANCE INSTITUTE OF HEALING",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1390 BROADWAY STE B297",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PLACERVILLE",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "95667-5900",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "925-519-3375",
"MailingAddressFaxNumber": "925-666-4741",
"FirstLinePracticeLocationAddress": "1390 BROADWAY STE B297",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PLACERVILLE",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "95667-5900",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "925-519-3375",
"PracticeLocationAddressFaxNumber": "925-666-4741",
"EnumerationDate": "12/21/2017",
"LastUpdateDate": "02/16/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MILES-MARANZ",
"AuthorizedOfficialFirstName": "KELLEE",
"AuthorizedOfficialMiddleName": "ANNETTE",
"AuthorizedOfficialTitle": "MFT CLINICIAN",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.A. MFT",
"AuthorizedOfficialTelephoneNumber": "925-519-3375",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "106H00000X",
"TaxonomyName": "Marriage & Family Therapist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"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."
}
}
}
}