{
"Npi": {
"NPI": "1093105850",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "WISE",
"FirstName": "KIMBERLY",
"MiddleName": "KATHLEEN",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "MA, LPC, NCC",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "TASKEY",
"OtherFirstName": "KIMBERLY",
"OtherMiddleName": "KATHLEEN",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "902 S CORONA ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DENVER",
"MailingAddressStateName": "CO",
"MailingAddressPostalCode": "80209-4412",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "720-839-8901",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1440 BLAKE ST",
"SecondLinePracticeLocationAddress": "SUITE 200",
"PracticeLocationAddressCityName": "DENVER",
"PracticeLocationAddressStateName": "CO",
"PracticeLocationAddressPostalCode": "80202-1474",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "720-839-8901",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/02/2015",
"LastUpdateDate": "02/02/2015",
"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": "11886",
"LicenseNumberStateCode": "CO",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}