{
"Npi": {
"NPI": "1306483508",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "ACHIEVE WELLNESS, LLC",
"ParentOrgTIN": null,
"OrgName": "ACHIEVE WELLNESS CLINIC",
"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": "3300 BIRCH ST STE 1B",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "EAU CLAIRE",
"MailingAddressStateName": "WI",
"MailingAddressPostalCode": "54703-2297",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "715-832-9467",
"MailingAddressFaxNumber": "715-832-9574",
"FirstLinePracticeLocationAddress": "1417 WINCHESTER WAY",
"SecondLinePracticeLocationAddress": "SUITE 6",
"PracticeLocationAddressCityName": "ALTOONA",
"PracticeLocationAddressStateName": "WI",
"PracticeLocationAddressPostalCode": "54720-5472",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "715-514-4734",
"PracticeLocationAddressFaxNumber": "715-832-9574",
"EnumerationDate": "12/06/2019",
"LastUpdateDate": "03/21/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GUILLIAMS-CHAN",
"AuthorizedOfficialFirstName": "CATHERINE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CHIEF EXECUTIVE OFFICER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "715-832-9467",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2300X",
"TaxonomyName": "Primary Care Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}