{
"Npi": {
"NPI": "1205094273",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "MCINTOSH-KOONTZ",
"FirstName": "LEITA",
"MiddleName": "JANI",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "MFT",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "KOONTZ",
"OtherFirstName": "LEITA",
"OtherMiddleName": "JANI",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "MFT",
"OtherLastNameTypeCode": "2",
"FirstLineMailingAddress": "11772 SORRENTO VALLEY RD",
"SecondLineMailingAddress": "#157",
"MailingAddressCityName": "SAN DIEGO",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92121-1015",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "619-654-3724",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "11772 SORRENTO VALLEY RD",
"SecondLinePracticeLocationAddress": "#157",
"PracticeLocationAddressCityName": "SAN DIEGO",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92121-1015",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "619-654-3724",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "05/27/2008",
"LastUpdateDate": "05/27/2008",
"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": "106H00000X",
"TaxonomyName": "Marriage & Family Therapist",
"LicenseNumber": "MFC #37514",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}