{
"Npi": {
"NPI": "1235682360",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "TREE OF LIFE CHRISTIAN WILDERNESS EXPEDITIONS",
"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": "PO BOX 1035",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "KLAMATH FALLS",
"MailingAddressStateName": "OR",
"MailingAddressPostalCode": "97601-0392",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "541-281-2956",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "5728 S 6TH ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "KLAMATH FALLS",
"PracticeLocationAddressStateName": "OR",
"PracticeLocationAddressPostalCode": "97603-5108",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "541-281-2956",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/25/2016",
"LastUpdateDate": "07/25/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "YAHNE",
"AuthorizedOfficialFirstName": "JAMES",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "DIRECTOR/COUNSELOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MAC,CADC III",
"AuthorizedOfficialTelephoneNumber": "541-281-2956",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "101Y00000X",
"TaxonomyName": "Counselor",
"LicenseNumber": "96-10-89",
"LicenseNumberStateCode": "OR",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}