{
"Npi": {
"NPI": "1386455012",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "TWO MINDS CONNECT, 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": "7333 NEW HAMPSHIRE AVE APT 214S",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "TAKOMA PARK",
"MailingAddressStateName": "MD",
"MailingAddressPostalCode": "20912-6959",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "720-819-3064",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1655 FORT MYER DR STE 717",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ARLINGTON",
"PracticeLocationAddressStateName": "VA",
"PracticeLocationAddressPostalCode": "22209-3113",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "617-820-3196",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "01/14/2025",
"LastUpdateDate": "05/24/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TAYLOR",
"AuthorizedOfficialFirstName": "ZYAIRE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CO-OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RN",
"AuthorizedOfficialTelephoneNumber": "720-819-3064",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "302R00000X",
"TaxonomyName": "Health Maintenance Organization",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "251S00000X",
"TaxonomyName": "Community/Behavioral Health Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}