{
"Npi": {
"NPI": "1235967092",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "NICKELS",
"FirstName": "TINA",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "LPC",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2600 S SUNSET AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LITTLEFIELD",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "79339-4809",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "806-485-8100",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2600 S SUNSET AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LITTLEFIELD",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "79339-4809",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "806-485-8100",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/23/2024",
"LastUpdateDate": "07/23/2024",
"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": "82061",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}