{
"Npi": {
"NPI": "1356670079",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "KATHLEEN D. MOSBY, PH.D.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": "6919 VANCOUVER ROAD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SPRINGFIELD",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "22152",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "703-569-6212",
"MailingAddressFaxNumber": "703-913-7456",
"FirstLinePracticeLocationAddress": "6919 VANCOUVER ROAD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SPRINGFIELD",
"PracticeLocationAddressStateName": "VA",
"PracticeLocationAddressPostalCode": "22152",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "703-569-6212",
"PracticeLocationAddressFaxNumber": "703-913-7456",
"EnumerationDate": "12/08/2009",
"LastUpdateDate": "12/08/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MOSBY",
"AuthorizedOfficialFirstName": "KATHLEEN",
"AuthorizedOfficialMiddleName": "D.",
"AuthorizedOfficialTitle": "OWNER7035696212",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PH.D. LLC",
"AuthorizedOfficialTelephoneNumber": "703-569-6212",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "103TC0700X",
"TaxonomyName": "Clinical Psychologist",
"LicenseNumber": "935",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}