{
"Npi": {
"NPI": "1376704262",
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"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "KERSTEN COUNSELING CENTER, LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherLastName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "10701 LOMAS BLVD NE",
"SecondLineMailingAddress": "SUITE 204",
"MailingAddressCityName": "ALBUQUERQUE",
"MailingAddressStateName": "NM",
"MailingAddressPostalCode": "87112-5463",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "505-550-9255",
"MailingAddressFaxNumber": "505-298-4900",
"FirstLinePracticeLocationAddress": "10701 LOMAS BLVD NE",
"SecondLinePracticeLocationAddress": "SUITE 204",
"PracticeLocationAddressCityName": "ALBUQUERQUE",
"PracticeLocationAddressStateName": "NM",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "505-550-9255",
"PracticeLocationAddressFaxNumber": "505-298-2900",
"EnumerationDate": "06/23/2008",
"LastUpdateDate": "06/23/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KERSTEN",
"AuthorizedOfficialFirstName": "SUZANNE",
"AuthorizedOfficialMiddleName": "H.",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LISW",
"AuthorizedOfficialTelephoneNumber": "505-550-9255",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1041C0700X",
"TaxonomyName": "Clinical Social Worker",
"LicenseNumber": "I-05378",
"LicenseNumberStateCode": "NM",
"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."
}
}
}
}