{
"Npi": {
"NPI": "1104551803",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "MOORE",
"FirstName": "ANNA-MAE",
"MiddleName": "EVANGELINE CONRAD",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "MSW",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "CONRAD",
"OtherFirstName": "ANNA MAE",
"OtherMiddleName": "EVANGELINE",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "58923 BUSINESS CENTER DR STE A-E",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "YUCCA VALLEY",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92284-7311",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "58923 BUSINESS CENTER DR STE A-E",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "YUCCA VALLEY",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92284-7311",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "760-365-7209",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/18/2022",
"LastUpdateDate": "07/20/2022",
"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": "101YM0800X",
"TaxonomyName": "Mental Health Counselor",
"LicenseNumber": "ASW108530",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "1041C0700X",
"TaxonomyName": "Clinical Social Worker",
"LicenseNumber": "ASW108530",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}