{
"Npi": {
"NPI": "1063300713",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "BOURRIAGUE",
"FirstName": "JACQUELINE",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "OTTOSEN",
"OtherFirstName": "JACKIE",
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "608 MOUNTAIN VIEW DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "KALISPELL",
"MailingAddressStateName": "MT",
"MailingAddressPostalCode": "59901-6699",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "425-772-8376",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2282 US HIGHWAY 93 S",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "KALISPELL",
"PracticeLocationAddressStateName": "MT",
"PracticeLocationAddressPostalCode": "59901-8499",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "406-890-2570",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/24/2025",
"LastUpdateDate": "06/24/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "101YP2500X",
"TaxonomyName": "Professional Counselor",
"LicenseNumber": "BBH-PCLC-LIC-79732",
"LicenseNumberStateCode": "MT",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}