{
"Npi": {
"NPI": "1114485976",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "CHABAI",
"FirstName": "MARISSA",
"MiddleName": "E",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "LPC, RN",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "HEEBNER",
"OtherFirstName": "MARISSA",
"OtherMiddleName": "E",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "333 MAYNARD ST STE 402",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ANN ARBOR",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48104-2282",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "269-998-1005",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "102 GERANIUM WAY",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BLACK HAWK",
"PracticeLocationAddressStateName": "CO",
"PracticeLocationAddressPostalCode": "80422-4315",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "703-402-2556",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/11/2019",
"LastUpdateDate": "01/15/2025",
"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": "163W00000X",
"TaxonomyName": "Registered Nurse",
"LicenseNumber": "1629875",
"LicenseNumberStateCode": "CO",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "101YM0800X",
"TaxonomyName": "Mental Health Counselor",
"LicenseNumber": "LPC.0019399",
"LicenseNumberStateCode": "CO",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}