{
"Npi": {
"NPI": "1245935949",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "WISE MIND SOLUTIONS, LLC",
"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": "550 SE 6TH AVE STE 200E2",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DELRAY BEACH",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33483-5306",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "561-255-7239",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "550 SE 6TH AVE STE 200E2",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "DELRAY BEACH",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33483-5306",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "561-255-7239",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/03/2023",
"LastUpdateDate": "04/03/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CHAMBERS",
"AuthorizedOfficialFirstName": "NADENE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CEO/PROVIDER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PSY.D",
"AuthorizedOfficialTelephoneNumber": "561-255-7239",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "103TC0700X",
"TaxonomyName": "Clinical Psychologist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X 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."
}
}
}
}