{
"Npi": {
"NPI": "1255851283",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "YOUR LONG RUN 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": "2742 FLETCHER ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SALEM",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "24153-2124",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "540-525-8113",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2742 FLETCHER ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SALEM",
"PracticeLocationAddressStateName": "VA",
"PracticeLocationAddressPostalCode": "24153-2124",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "540-525-8113",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/21/2017",
"LastUpdateDate": "07/21/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BUSH",
"AuthorizedOfficialFirstName": "KATHY",
"AuthorizedOfficialMiddleName": "K",
"AuthorizedOfficialTitle": "PRESIDENT/PROVIDER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LPC",
"AuthorizedOfficialTelephoneNumber": "540-525-8113",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "101YA0400X",
"TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
"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."
}
}
}
}