{
"Npi": {
"NPI": "1154836930",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BRANDON HOLLISTER, PH.D., 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": "21410 MCCLELLAN CIR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GRETNA",
"MailingAddressStateName": "NE",
"MailingAddressPostalCode": "68028-6910",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "402-460-7282",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "21410 MCCLELLAN CIR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GRETNA",
"PracticeLocationAddressStateName": "NE",
"PracticeLocationAddressPostalCode": "68028-6910",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "402-460-7282",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "12/03/2017",
"LastUpdateDate": "03/17/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HOLLISTER",
"AuthorizedOfficialFirstName": "BRANDON",
"AuthorizedOfficialMiddleName": "ALAN",
"AuthorizedOfficialTitle": "LICENSED PSYCHOLOGIST",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PH.D.",
"AuthorizedOfficialTelephoneNumber": "402-460-7282",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QM0801X",
"TaxonomyName": "Mental Health Clinic/Center (Including Community Mental Health Center)",
"LicenseNumber": "943",
"LicenseNumberStateCode": "NE",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}