{
"Npi": {
"NPI": "1326919028",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "INNER WEST PSYCHIATRY AND WELLNESS CENTER 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": "677 CRAIG RD STE 203",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CREVE COEUR",
"MailingAddressStateName": "MO",
"MailingAddressPostalCode": "63141-7125",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "314-220-8685",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "677 CRAIG RD STE 203",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CREVE COEUR",
"PracticeLocationAddressStateName": "MO",
"PracticeLocationAddressPostalCode": "63141-7125",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "314-220-8685",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/16/2025",
"LastUpdateDate": "09/16/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BAUER",
"AuthorizedOfficialFirstName": "REGINA",
"AuthorizedOfficialMiddleName": "JASMINE",
"AuthorizedOfficialTitle": "PMHNP",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PMHNP",
"AuthorizedOfficialTelephoneNumber": "314-327-5425",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "261Q00000X",
"TaxonomyName": "Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "261QM0801X",
"TaxonomyName": "Mental Health Clinic/Center (Including Community Mental Health Center)",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}