{
"Npi": {
"NPI": "1417182031",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "OTTO",
"FirstName": "LAURA",
"MiddleName": "LYNN",
"NamePrefix": "MRS.",
"NameSuffix": null,
"Credential": "LMHC, LPC, NCC, CCMH",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "DEEMS",
"OtherFirstName": "LAURA",
"OtherMiddleName": "LYNN",
"OtherNamePrefix": "MS.",
"OtherNameSuffix": null,
"OtherCredential": "LMHC, LPC, NCC, CCMH",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "583 SKIPPACK PIKE STE 410",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BLUE BELL",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "19422-2146",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "267-405-6803",
"MailingAddressFaxNumber": "267-604-9091",
"FirstLinePracticeLocationAddress": "583 SKIPPACK PIKE STE 410",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BLUE BELL",
"PracticeLocationAddressStateName": "PA",
"PracticeLocationAddressPostalCode": "19422-2146",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "267-405-6803",
"PracticeLocationAddressFaxNumber": "267-604-9091",
"EnumerationDate": "05/27/2009",
"LastUpdateDate": "01/29/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "101YP2500X",
"TaxonomyName": "Professional Counselor",
"LicenseNumber": "004912",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "101YP2500X",
"TaxonomyName": "Professional Counselor",
"LicenseNumber": "PC006387",
"LicenseNumberStateCode": "PA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}