{
"Npi": {
"NPI": "1093466872",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "TEASLEY",
"FirstName": "SHELBY",
"MiddleName": "COSHETTA",
"NamePrefix": "MS.",
"NameSuffix": null,
"Credential": "QMHP-A,C",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "BREEDLOVE",
"OtherFirstName": "WAYNE",
"OtherMiddleName": null,
"OtherNamePrefix": "MR.",
"OtherNameSuffix": null,
"OtherCredential": "QMHP,A,C",
"OtherLastNameTypeCode": "2",
"FirstLineMailingAddress": "7300 HANOVER GREEN DR STE 300-A",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MECHANICSVILLE",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "23111-1705",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "804-497-9064",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "7300 HANOVER GREEN DR STE 300-A",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MECHANICSVILLE",
"PracticeLocationAddressStateName": "VA",
"PracticeLocationAddressPostalCode": "23111-1705",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "804-497-9064",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "01/13/2022",
"LastUpdateDate": "01/13/2022",
"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": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}