{
"Npi": {
"NPI": "1194078568",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "GOLD",
"FirstName": "ELLEN",
"MiddleName": null,
"NamePrefix": "MRS.",
"NameSuffix": null,
"Credential": "MPS, BCDMT, LPC",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "YACOE",
"OtherFirstName": "ELLEN",
"OtherMiddleName": "GOLD",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "2",
"FirstLineMailingAddress": "11726 LARIAT LN",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "OAKTON",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "22124-2323",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "703-860-8188",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "11726 LARIAT LANEE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "OAKTON",
"PracticeLocationAddressStateName": "VA",
"PracticeLocationAddressPostalCode": "22124",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "703-860-8188",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/22/2012",
"LastUpdateDate": "10/22/2012",
"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": "101YP2500X",
"TaxonomyName": "Professional Counselor",
"LicenseNumber": "37PC00234600",
"LicenseNumberStateCode": "NJ",
"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."
}
}
}
}