{
"Npi": {
"NPI": "1235590258",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "JOHNSON",
"FirstName": "ALYSA",
"MiddleName": "HARLESS",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "LCSW",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "HARLESS",
"OtherFirstName": "ALYSA",
"OtherMiddleName": null,
"OtherNamePrefix": "MISS",
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "11354 PLEASANT VALLEY RD # 94",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PENN VALLEY",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "95946-9000",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "906-407-0047",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "14011 LODGEPOLE CT",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PENN VALLEY",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "95946-9128",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "906-407-0047",
"PracticeLocationAddressFaxNumber": "916-405-4002",
"EnumerationDate": "03/18/2016",
"LastUpdateDate": "03/09/2022",
"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": "1041C0700X",
"TaxonomyName": "Clinical Social Worker",
"LicenseNumber": "77484",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}