{
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"OrgName": "WW BEHAVIOR CONSULTING",
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "76 CHAMPAGNE DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MORGANTOWN",
"MailingAddressStateName": "WV",
"MailingAddressPostalCode": "26508-5223",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "304-692-1820",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "76 CHAMPAGNE DR",
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"PracticeLocationAddressCityName": "MORGANTOWN",
"PracticeLocationAddressStateName": "WV",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "304-692-1820",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/27/2017",
"LastUpdateDate": "07/21/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WAGONER",
"AuthorizedOfficialFirstName": "REGINNA",
"AuthorizedOfficialMiddleName": "LEIGH",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "BCBA",
"AuthorizedOfficialTelephoneNumber": "304-692-1820",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "103K00000X",
"TaxonomyName": "Behavior Analyst",
"LicenseNumber": "1-12-10533",
"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."
}
}
}
}