{
"Npi": {
"NPI": "1083981724",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "STEPHEN BURDEN DBA MARY LEE COMMUNITY HEALTH & TRAINING CENTER",
"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": "24633 PEMBROOKE DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SOUTHFIELD",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48033-3159",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "248-719-4335",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "25822 W 6 MILE RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "REDFORD",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "48240-2211",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "313-286-3031",
"PracticeLocationAddressFaxNumber": "313-286-3135",
"EnumerationDate": "11/23/2011",
"LastUpdateDate": "02/07/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MOSS",
"AuthorizedOfficialFirstName": "TONYA",
"AuthorizedOfficialMiddleName": "MARETTA",
"AuthorizedOfficialTitle": "CLINICAL DIRECTOR",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DNP, NP-C",
"AuthorizedOfficialTelephoneNumber": "313-286-3031",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QC1500X",
"TaxonomyName": "Community Health Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}