{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "TERRI SQUIRES, LPC, FNP-C, PNP-C, APRN-RX",
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"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
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"FirstLineMailingAddress": "PO BOX 3629",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "TELLURIDE",
"MailingAddressStateName": "CO",
"MailingAddressPostalCode": "81435-3629",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "808-866-6533",
"MailingAddressFaxNumber": "888-338-7728",
"FirstLinePracticeLocationAddress": "560 MOUNTAIN VILLAGE BLVD # 102A-B",
"SecondLinePracticeLocationAddress": "SUITE 102A-B",
"PracticeLocationAddressCityName": "TELLURIDE",
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"PracticeLocationAddressPostalCode": "81435-9513",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "808-866-6533",
"PracticeLocationAddressFaxNumber": "888-338-7728",
"EnumerationDate": "02/01/2016",
"LastUpdateDate": "02/01/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SQUIRES",
"AuthorizedOfficialFirstName": "TERRI",
"AuthorizedOfficialMiddleName": "LEIGH",
"AuthorizedOfficialTitle": "CEO",
"AuthorizedOfficialNamePrefix": "PROF.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LPC, FNP-C, PNP-C,",
"AuthorizedOfficialTelephoneNumber": "808-866-6533",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "363LP0808X",
"TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
"LicenseNumber": "5346",
"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."
}
}
}
}