{
"Npi": {
"NPI": "1437572450",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "JOCELYN TELLO PSYD INC",
"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": "400 E EVERGREEN BLVD",
"SecondLineMailingAddress": "SUITE 313",
"MailingAddressCityName": "VANCOUVER",
"MailingAddressStateName": "WA",
"MailingAddressPostalCode": "98660-3331",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "360-931-0605",
"MailingAddressFaxNumber": "360-859-4533",
"FirstLinePracticeLocationAddress": "400 E EVERGREEN BLVD",
"SecondLinePracticeLocationAddress": "SUITE 313",
"PracticeLocationAddressCityName": "VANCOUVER",
"PracticeLocationAddressStateName": "WA",
"PracticeLocationAddressPostalCode": "98660-3331",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "360-931-0605",
"PracticeLocationAddressFaxNumber": "360-859-4533",
"EnumerationDate": "01/27/2014",
"LastUpdateDate": "01/27/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TELLO",
"AuthorizedOfficialFirstName": "JOCELYN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PSYD",
"AuthorizedOfficialTelephoneNumber": "360-931-0605",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QM0801X",
"TaxonomyName": "Mental Health Clinic/Center (Including Community Mental Health Center)",
"LicenseNumber": "PY00003900",
"LicenseNumberStateCode": "WA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}