{
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"EIN": null,
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"IsOrgSubpart": "N",
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"LastName": null,
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"NamePrefix": null,
"NameSuffix": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "6301 FORBES AVE STE 240",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PITTSBURGH",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "15217-1725",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "412-378-9559",
"MailingAddressFaxNumber": "412-727-1102",
"FirstLinePracticeLocationAddress": "6301 FORBES AVE STE 240",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PITTSBURGH",
"PracticeLocationAddressStateName": "PA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "412-378-9559",
"PracticeLocationAddressFaxNumber": "412-727-1102",
"EnumerationDate": "08/10/2017",
"LastUpdateDate": "07/21/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FATH",
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"AuthorizedOfficialMiddleName": "M.",
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"AuthorizedOfficialCredential": "LPC",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QM0850X",
"TaxonomyName": "Adult Mental Health Clinic/Center",
"LicenseNumber": "PC005725",
"LicenseNumberStateCode": "PA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}