{
"Npi": {
"NPI": "1215060538",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "MOSS",
"FirstName": "NAN",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "LCPC, LPC",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 971",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ONTARIO",
"MailingAddressStateName": "OR",
"MailingAddressPostalCode": "97914-0971",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "541-212-3151",
"MailingAddressFaxNumber": "208-452-1232",
"FirstLinePracticeLocationAddress": "1509 N WHITLEY DR STE 11",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FRUITLAND",
"PracticeLocationAddressStateName": "ID",
"PracticeLocationAddressPostalCode": "83619-2260",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "541-212-3151",
"PracticeLocationAddressFaxNumber": "208-452-1232",
"EnumerationDate": "03/14/2007",
"LastUpdateDate": "07/11/2008",
"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": "101YM0800X",
"TaxonomyName": "Mental Health Counselor",
"LicenseNumber": "C1279",
"LicenseNumberStateCode": "OR",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "101YM0800X",
"TaxonomyName": "Mental Health Counselor",
"LicenseNumber": "LCPC-120",
"LicenseNumberStateCode": "ID",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}