{
"Npi": {
"NPI": "1104095868",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "WAYNE STATE UNIVERSITY PSYCHOLOGY CLINIC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "60 FARNSWORTH ST, RACKHAM BLDG",
"SecondLineMailingAddress": "RM. 109",
"MailingAddressCityName": "DETROIT",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48202",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "313-577-2840",
"MailingAddressFaxNumber": "313-577-8949",
"FirstLinePracticeLocationAddress": "60 FARNSWORTH ST, RACKHAM BLDG",
"SecondLinePracticeLocationAddress": "RM. 109",
"PracticeLocationAddressCityName": "DETROIT",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "48202-4060",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "313-577-2840",
"PracticeLocationAddressFaxNumber": "313-577-8949",
"EnumerationDate": "02/27/2008",
"LastUpdateDate": "02/27/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BARNETT",
"AuthorizedOfficialFirstName": "DOUGLAS",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "DIRECTOR",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PH.D.",
"AuthorizedOfficialTelephoneNumber": "313-577-2840",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251S00000X",
"TaxonomyName": "Community/Behavioral Health Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}