{
"Npi": {
"NPI": "1427577022",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "A PATH TO CHANGE, 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": "15 SUNSET AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "OLD SAYBROOK",
"MailingAddressStateName": "CT",
"MailingAddressPostalCode": "06475-1427",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "860-876-0881",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2 CENTER RD W STE 2",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "OLD SAYBROOK",
"PracticeLocationAddressStateName": "CT",
"PracticeLocationAddressPostalCode": "06475-4052",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "860-294-4505",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/14/2017",
"LastUpdateDate": "09/14/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MCLAIN",
"AuthorizedOfficialFirstName": "MICHELLE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LPC",
"AuthorizedOfficialTelephoneNumber": "860-876-0881",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "101YP2500X",
"TaxonomyName": "Professional Counselor",
"LicenseNumber": "002359",
"LicenseNumberStateCode": "CT",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}