{
"Npi": {
"NPI": "1417261694",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "MIYAKE",
"FirstName": "CRISSY",
"MiddleName": "TAMIKO",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "PSY.D.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "MCNEAL",
"OtherFirstName": "CRISSY",
"OtherMiddleName": "TAMIKO",
"OtherNamePrefix": "DR.",
"OtherNameSuffix": null,
"OtherCredential": "PSY.D.",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "5351C JAYCEE AVE",
"SecondLineMailingAddress": "SUITE 1",
"MailingAddressCityName": "HARRISBURG",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "17112-2997",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "717-657-2080",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "5351C JAYCEE AVE",
"SecondLinePracticeLocationAddress": "SUITE 1",
"PracticeLocationAddressCityName": "HARRISBURG",
"PracticeLocationAddressStateName": "PA",
"PracticeLocationAddressPostalCode": "17112-2997",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "717-657-2080",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/30/2010",
"LastUpdateDate": "07/30/2010",
"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": "103TC0700X",
"TaxonomyName": "Clinical Psychologist",
"LicenseNumber": "PS016761",
"LicenseNumberStateCode": "PA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}