{
"Npi": {
"NPI": "1134510795",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BEAUTY FOR ASHES, LLC",
"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": "849 E 33RD ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "EDMOND",
"MailingAddressStateName": "OK",
"MailingAddressPostalCode": "73013-5407",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "405-888-5299",
"MailingAddressFaxNumber": "405-888-5322",
"FirstLinePracticeLocationAddress": "849 E 33RD ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "EDMOND",
"PracticeLocationAddressStateName": "OK",
"PracticeLocationAddressPostalCode": "73013-5407",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "405-888-5299",
"PracticeLocationAddressFaxNumber": "405-888-5322",
"EnumerationDate": "02/17/2015",
"LastUpdateDate": "10/30/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GOLDSMITH-NICKELBERRY",
"AuthorizedOfficialFirstName": "PORTIA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER/OPERATOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LCSW",
"AuthorizedOfficialTelephoneNumber": "405-367-9034",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "101YM0800X",
"TaxonomyName": "Mental Health Counselor",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "1041C0700X",
"TaxonomyName": "Clinical Social Worker",
"LicenseNumber": "4889",
"LicenseNumberStateCode": "OK",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": [
{
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
},
{
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
]
}
}
}